{ "hospital_name": "Dallas Regional Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Dallas Regional Medical Center" ], "hospital_address": [ "1011 North Galloway Avenue Mesquite, TX 75149" ], "license_information": { "license_number": "472177648", "state": "TX" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Josiah De La Garza" }, "type_2_npi": [ "1790174860" ], "standard_charge_information": [ { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11058.0, "minimum": 5600.0, "maximum": 18245.931, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16587.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16587.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12163.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9772.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11789.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13099.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13099.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11058.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10505.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11389.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11058.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18245.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14375.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13822.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11721.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11611.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11611.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17140.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17693.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11611.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14375.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18245.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15481.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11058.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7474.77 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10836.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11058.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16034.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11058.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11942.79, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15813.14, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9896.0, "minimum": 4016.73, "maximum": 27057.6571, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14844.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14844.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10886.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11448.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13811.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15345.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15345.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9401.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10193.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16329.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12865.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12370.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10490.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10391.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10391.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15339.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15834.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10391.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12865.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16329.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13854.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4016.73 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9698.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14349.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9896.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10688.09, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14151.82, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10532.0, "minimum": 9515.98, "maximum": 17378.9385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15799.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15799.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11585.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11263.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13588.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15098.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15098.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10532.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10006.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10848.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10532.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17378.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13692.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13165.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11164.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11059.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11059.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16325.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16852.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11059.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13692.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17378.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14745.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9515.98 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10322.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10532.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15272.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11375.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15061.75, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16127.0, "minimum": 6743.59, "maximum": 26609.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24190.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 24190.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17739.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18075.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21805.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24228.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24228.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15320.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16610.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26609.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20965.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20158.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17094.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16933.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16933.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24996.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25803.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16933.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20965.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26609.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22577.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6743.59 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15804.46, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23384.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16127.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17417.16, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23061.61, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10752.0, "minimum": 5752.32, "maximum": 17741.1795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16128.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16128.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11827.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10752.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10214.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11074.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10752.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17741.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13977.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13440.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11397.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11289.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11289.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16665.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17203.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11289.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13977.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17741.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15053.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10752.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5752.32 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10537.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10752.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15590.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10752.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11612.41, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15375.69, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23320.0, "minimum": 16613.2577, "maximum": 39544.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 34980.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 34980.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 25652.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29501.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35590.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39544.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39544.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 23320.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22154.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 24019.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23320.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 38478.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30316.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29150.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24719.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 24486.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 24486.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 36146.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 37312.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24486.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 30316.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 38478.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 32648.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23320.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26182.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22853.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 23320.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 33814.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23320.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25185.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 33347.61, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43357.0, "minimum": 20301.0914, "maximum": 89238.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 65035.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 65035.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 47692.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66575.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80315.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89238.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89238.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 43357.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41189.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 44657.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43357.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 71539.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56364.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54196.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45958.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 45525.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 45525.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 67203.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 69371.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 45525.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 56364.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 71539.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 60700.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43357.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79744.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42490.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 43357.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 62867.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43357.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46825.77, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 62000.78, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15387.0, "minimum": 8945.6003, "maximum": 25388.6325, "payers_information": [ { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25388.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20003.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19233.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16310.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18450.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16156.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16156.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23849.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24619.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16156.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20003.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25388.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21541.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15387.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13340.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15079.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15387.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22311.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16618.01, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22003.48, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23080.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23080.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16925.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17894.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21587.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23986.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23986.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15387.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14617.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15848.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15387.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15387.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12214.0, "minimum": 4227.77, "maximum": 20153.3475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18321.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18321.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13435.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13080.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15779.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17533.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17533.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12214.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11603.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12580.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12214.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20153.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15878.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15267.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12947.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12824.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12824.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18931.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19542.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12824.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15878.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20153.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17099.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12214.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4227.77 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11969.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12214.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17710.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12214.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13191.28, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17466.23, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18098.0, "minimum": 6737.1826, "maximum": 29862.6075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27147.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 27147.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19908.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20518.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24752.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27502.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27502.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18098.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17193.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18641.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18098.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29862.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23528.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22623.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19184.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19003.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19003.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 28052.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28957.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19003.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23528.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29862.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25337.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18098.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24761.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17736.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18098.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26242.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19546.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25880.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9496.0, "minimum": 2711.09, "maximum": 15669.8685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14245.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14245.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10446.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7084.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8546.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9496.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9496.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9022.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9781.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15669.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12345.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11871.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10066.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9971.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9971.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14720.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15195.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9971.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12345.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15669.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13295.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2711.09 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9306.95, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13770.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9496.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10256.64, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13580.55, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18854.0, "minimum": 11869.3935, "maximum": 31177.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28281.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28281.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20739.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23259.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28059.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31177.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31177.08 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18854.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17911.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19419.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18854.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31109.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24510.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23567.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19985.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19797.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19797.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29224.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30166.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19797.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24510.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31109.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26396.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18854.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17671.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18477.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18854.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27338.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20362.69, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26961.71, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10456.0, "minimum": 7037.9323, "maximum": 17253.0435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15684.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15684.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11502.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10256.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12373.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13748.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13748.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10456.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9933.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10770.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10456.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17253.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13593.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13070.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11083.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10979.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10979.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16207.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16730.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10979.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13593.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17253.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14638.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8993.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10247.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10456.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15161.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11292.9, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14952.64, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12618.0, "minimum": 10800.0, "maximum": 52948.1903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13880.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12870.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15526.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17251.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17251.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12618.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11987.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12997.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12618.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20820.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16404.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15773.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13375.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13249.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13249.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19558.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20189.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13249.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16404.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20820.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17666.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12618.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12351.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12366.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12618.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18297.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12618.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13628.17, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18044.71, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8823.0, "minimum": 5829.0937, "maximum": 14558.1975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13234.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13234.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9705.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8079.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9746.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10829.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10829.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8381.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9087.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14558.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11470.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11028.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9352.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9264.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9264.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13675.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14117.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9264.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11470.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14558.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12352.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7202.44 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8646.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12793.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8823.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9529.0, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12617.1, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9045.0, "minimum": 7650.0, "maximum": 21830.3968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13568.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13568.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9950.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7983.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9631.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10701.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10701.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8593.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9316.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14925.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11759.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11306.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9588.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9497.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9497.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14020.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14472.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9497.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11759.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14925.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12663.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8066.74 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8864.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13116.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9045.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9769.22, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12935.17, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13912.0, "minimum": 6750.0, "maximum": 38434.6354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20869.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20869.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15304.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17321.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20896.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23217.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23217.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13912.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13217.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14330.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13912.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22956.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18086.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17391.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14747.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14608.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14608.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21564.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22260.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14608.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18086.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22956.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19478.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14437.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13634.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13912.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20173.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15025.92, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19895.43, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19617.0, "minimum": 12150.0, "maximum": 35205.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29426.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 29426.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21579.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26264.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31684.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35205.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35205.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19617.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18636.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20205.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19617.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 32368.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25502.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24521.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20794.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20598.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20598.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30406.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 31387.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20598.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25502.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32368.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 27464.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19617.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23807.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19224.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19617.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 28445.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19617.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21186.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 28052.78, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8151.0, "minimum": 5457.22, "maximum": 24387.2688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12227.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12227.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8966.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5462.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6589.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7321.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7321.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7744.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8396.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13450.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10597.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10189.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8640.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8559.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8559.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12634.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13042.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8559.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10597.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13450.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11412.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5457.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7988.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 11819.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8151.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8803.71, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11656.76, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12404.0, "minimum": 6109.4041, "maximum": 21601.2, "payers_information": [ { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11783.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12776.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12404.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20466.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16125.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15505.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13148.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13024.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13024.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19226.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19846.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13024.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16125.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20466.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17365.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12404.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21601.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12156.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12404.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17986.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13396.51, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17737.98, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18606.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18606.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13644.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12182.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14696.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12404.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16329.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16329.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12404.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36681.0, "minimum": 8121.0, "maximum": 79856.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 55021.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 55021.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 40349.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59575.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71870.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79856.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79856.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 36681.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34846.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 37781.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36681.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 60523.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47685.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45851.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38881.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 38515.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 38515.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 56855.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 58689.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38515.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 47685.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 60523.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 51353.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36681.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47499.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 35947.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 36681.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 53187.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39615.49, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 52453.84, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11946.0, "minimum": 7824.3587, "maximum": 19711.527, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17919.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17919.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13141.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11844.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14289.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15876.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15876.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11946.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11349.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12304.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11946.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19711.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15530.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14933.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12663.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12543.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12543.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18516.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19114.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12543.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15530.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19711.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16724.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11946.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13657.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11707.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11946.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17322.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11946.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12902.09, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17083.32, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14030.0, "minimum": 6444.99, "maximum": 34200.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21045.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21045.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15433.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14030.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13328.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14451.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14030.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23149.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18239.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17537.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14872.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14731.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14731.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21746.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22448.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14731.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18239.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23149.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19642.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14030.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6444.99 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13749.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14030.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20343.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14030.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15152.64, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20063.21, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17264.0, "minimum": 10960.3313, "maximum": 28486.0785, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17782.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17264.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28486.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22443.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21580.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18300.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18127.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18127.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26759.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27622.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18127.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22443.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28486.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24170.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17264.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18043.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16919.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17264.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25033.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18645.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24687.93, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25896.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25896.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18990.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20554.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24796.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17264.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27551.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27551.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17264.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16401.08, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16401.0, "minimum": 10265.6, "maximum": 27063.2505, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24602.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 24602.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18042.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16401.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16894.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16401.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 27063.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21322.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20502.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17386.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17222.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17222.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25423.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 26243.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17222.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 21322.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 27063.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22962.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16401.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10265.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16073.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16401.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23782.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16402.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17714.13, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23454.82, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29884.0, "minimum": 18450.0, "maximum": 67541.0964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44826.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 44826.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32873.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37003.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44639.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49599.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49599.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 29884.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28390.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30781.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29884.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 49309.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38850.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37355.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31677.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 31378.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 31378.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 46321.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 47815.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31378.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 38850.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 49309.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 41838.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29884.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34673.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 29286.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 29884.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 43332.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29884.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32275.39, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 42735.01, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10195.0, "minimum": 9685.345, "maximum": 16821.915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15292.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15292.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11214.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 45.2, "median_amount": 17450.93, "10th_percentile": 17450.93, "90th_percentile": 17450.93, "count": "1 through 10" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9685.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10500.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16821.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13253.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12743.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10806.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10704.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15802.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16312.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10704.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13253.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16821.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14273.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9991.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14782.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10195.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11010.71, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14578.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8358.0, "minimum": 5411.548, "maximum": 17245.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12538.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12538.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9194.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8130.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9808.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10898.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10898.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7940.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8609.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13792.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10866.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10448.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8860.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8776.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8776.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12956.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13374.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8776.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10866.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13792.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11702.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17245.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8191.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12120.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8358.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9027.59, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11953.2, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9627.0, "minimum": 8705.26, "maximum": 15884.8305, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14440.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14440.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10589.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10501.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11668.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11668.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9145.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9915.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15884.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12515.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12033.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10204.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10108.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10108.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14922.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15403.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10108.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12515.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15884.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13478.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8748.89 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9434.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13959.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9627.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10397.34, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13766.85, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8281.0, "minimum": 3378.36, "maximum": 13663.881, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12421.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12421.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9109.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7867.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8529.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13663.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10765.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10351.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8778.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8695.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8695.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12835.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13249.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8695.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10765.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13663.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11593.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3378.36 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8115.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12007.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8281.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8943.63, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11842.03, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15944.0, "minimum": 6485.0979, "maximum": 26309.0685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23917.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23917.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17539.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18680.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22535.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25039.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25039.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15944.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15147.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16423.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15944.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26309.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20728.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19931.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16901.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16742.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16742.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24714.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25511.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16742.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20728.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26309.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22322.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15944.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13483.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15625.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15944.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23120.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17220.48, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22801.19, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8636.0, "minimum": 3867.87, "maximum": 17285.3364, "payers_information": [ { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14250.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11227.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10795.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9154.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9068.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9068.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13386.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13818.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9068.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11227.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14250.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12091.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3867.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8463.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12523.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9327.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12350.51, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12955.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12955.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9500.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7232.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8725.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9695.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9695.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8204.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8895.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8636.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 90345.0, "minimum": 85828.6905, "maximum": 149070.8835, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 135518.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 135518.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 99380.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 90345.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85828.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 93056.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90345.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 149070.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 117449.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 112932.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 95766.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 94863.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 94863.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 140036.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 144553.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 94863.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 117449.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 149070.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 126484.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 90345.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102851.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 88539.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 90345.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 131001.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 90346.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 97573.67, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 129194.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13805.0, "minimum": 13115.358, "maximum": 35187.8488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20708.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20708.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15186.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17511.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21125.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23473.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23473.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13805.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13115.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14219.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13805.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22779.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17947.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17257.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14633.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14495.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14495.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21398.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22089.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14495.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17947.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22779.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19327.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14676.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13529.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13805.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20018.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14910.09, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19742.07, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24358.0, "minimum": 13474.3652, "maximum": 41152.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 36538.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 36538.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 26794.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30701.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37037.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41152.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41152.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 24358.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23140.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 25089.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24358.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 40191.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31666.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30448.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25820.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 25576.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 25576.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 37755.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 38973.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25576.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 31666.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 40191.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 34102.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24358.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18249.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23871.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 24358.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 35320.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24358.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26307.37, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 34832.91, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10107.0, "minimum": 6462.5, "maximum": 16801.5145, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15160.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15160.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11118.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10776.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13000.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14444.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14444.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10107.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9601.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10410.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10107.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16677.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13139.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12634.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10713.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10612.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10612.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15666.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16171.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10612.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13139.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16677.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14150.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10107.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6462.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9905.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10107.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14655.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10915.86, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14453.41, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20221.0, "minimum": 18309.5, "maximum": 33365.0625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 30331.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 30331.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22243.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24138.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29120.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32355.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32355.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 20221.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19210.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20827.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20221.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 33365.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26287.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25276.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21434.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 21232.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 21232.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 31342.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 32354.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21232.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 26287.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 33365.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 28309.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20221.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18309.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19816.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 20221.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 29320.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20221.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21838.95, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 28916.39, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12335.0, "minimum": 7534.33, "maximum": 20354.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18503.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18503.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13569.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12762.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15396.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17107.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17107.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11719.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12705.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20354.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16036.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15419.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13075.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12952.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12952.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19120.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19737.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12952.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16036.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20354.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17270.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7534.33 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12089.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17886.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12335.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13322.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17640.19, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34741.0, "minimum": 33004.083, "maximum": 60073.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 52111.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 52111.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 38215.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44817.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54066.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60073.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60073.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 34741.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33004.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35783.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34741.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 57322.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 45163.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43426.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36825.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 36478.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 36478.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 53848.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 55585.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36478.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 45163.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 57322.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 48637.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34741.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50512.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 34046.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 34741.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 50374.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34741.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37520.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 49679.83, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39267.0, "minimum": 27743.9165, "maximum": 70928.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 58900.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 58900.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 43193.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52914.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63835.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70928.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70928.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 39267.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37303.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 40445.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39267.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 64790.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51047.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49084.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41623.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 41230.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 41230.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 60864.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 62827.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 41230.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 51047.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 64790.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 54974.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39267.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34654.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 38481.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 39267.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 56937.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39267.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42408.64, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 56152.18, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28943.0, "minimum": 18203.6299, "maximum": 58834.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 43414.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 43414.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 31837.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43892.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52951.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58834.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58834.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 28943.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27495.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 29811.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28943.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 47756.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37626.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36178.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30679.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 30390.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 30390.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 44861.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 46308.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30390.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 37626.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 47756.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 40520.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28943.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21500.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 28364.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 28943.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 41967.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28943.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31258.56, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 41388.65, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13261.0, "minimum": 11767.3, "maximum": 27463.2299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19892.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19892.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14587.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14771.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17820.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19800.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19800.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13261.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12598.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13659.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13261.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21881.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17239.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16576.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14057.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13924.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13924.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20555.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21218.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13924.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17239.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21881.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18566.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13261.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11767.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12996.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13261.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19229.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14322.38, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18963.89, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34239.0, "minimum": 6006.27, "maximum": 63640.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 51359.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 51359.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 37663.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47477.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 57276.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63640.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63640.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 34239.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32527.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35266.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34239.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 56495.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44511.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42799.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36293.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 35951.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 35951.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 53071.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 54783.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 35951.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 44511.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 56495.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 47935.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34239.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6006.27 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33554.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 34239.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 49647.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34239.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36978.58, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 48962.38, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17303.0, "minimum": 13311.2, "maximum": 30002.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25954.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25954.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19033.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22383.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27002.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30002.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30002.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17303.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16438.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17822.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17303.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28550.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22494.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21629.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18341.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18168.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18168.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26819.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27685.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18168.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22494.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28550.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24224.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13311.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16957.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17303.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25089.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17303.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18687.41, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24743.52, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14049.0, "minimum": 12102.7, "maximum": 31822.0354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21074.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21074.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15454.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14338.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17297.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19219.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19219.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14049.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13347.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14471.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14049.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23181.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18264.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17562.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14892.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14752.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14752.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21776.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22479.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14752.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18264.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23181.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19669.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14049.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12102.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13768.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14049.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20372.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15173.62, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20091.0, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8686.0, "minimum": 4562.28, "maximum": 17366.8918, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13029.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13029.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9555.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7443.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8979.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9976.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9976.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8252.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8946.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14332.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11292.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10857.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9207.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9120.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13463.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13898.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9120.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11292.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14332.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12160.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4562.28 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8512.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12595.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8686.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9381.3, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12421.54, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20364.0, "minimum": 8473.5498, "maximum": 36308.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 30546.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 30546.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22400.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27087.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32677.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36308.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36308.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 20364.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19346.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20975.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20364.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 33601.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26473.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25455.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21586.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 21382.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 21382.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 31564.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 32583.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21382.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 26473.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 33601.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 28510.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20364.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23004.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19957.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 20364.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 29528.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21993.65, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 29121.22, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53348.0, "minimum": 13213.1, "maximum": 102580.35, "payers_information": [ { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53348.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 88024.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 69352.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66685.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56548.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 56015.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 56015.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 82689.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 85356.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 56015.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 69352.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 88024.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 74687.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53348.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13213.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 52281.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 53348.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 77354.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57615.92, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 76287.74, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 80022.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 80022.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 58682.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 76528.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92322.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 102580.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 102580.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 53348.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50680.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 54948.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 53348.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8892.0, "minimum": 5781.22, "maximum": 22980.9892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13339.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13339.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9782.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7669.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9252.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10280.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10280.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8448.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9159.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14673.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11560.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11116.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9426.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9337.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9337.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13784.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14228.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9337.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11560.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14673.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12450.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5781.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8715.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12894.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8892.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9604.41, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12716.95, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Appendectomy add-on", "code_information": [ { "code": "44955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31239.42, "minimum": 344.0, "maximum": 30614.6316, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Av Fuse Uppr Arm Basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38997.0, "discounted_cash": 5562.0, "minimum": 1684.67, "maximum": 38217.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33893.1, "discounted_cash": 3156.0, "minimum": 1464.18, "maximum": 33215.238, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4655.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5625.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6235.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6235.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1468.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1688.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21079.0, "minimum": 20025.297, "maximum": 34780.779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31618.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 31618.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23187.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21079.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20025.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21711.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21079.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 34780.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27403.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26349.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22344.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22133.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22133.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 32672.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 33726.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22133.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 27403.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 34780.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 29510.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21079.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25469.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20657.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21079.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 30564.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21079.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22765.6, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30143.34, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14735.0, "minimum": 13500.0, "maximum": 24313.773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22103.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22103.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16209.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14735.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13998.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15177.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14735.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24313.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19156.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18419.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15619.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22500.0, "10th_percentile": 22500.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15472.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15472.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22840.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 23576.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15472.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19156.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24313.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 20629.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14735.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22901.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14440.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14735.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21366.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15914.47, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21071.94, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14593.0, "minimum": 9000.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21890.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21890.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16053.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15597.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18815.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20906.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20906.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14593.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13864.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15031.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14593.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24079.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18971.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18242.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15469.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15323.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15323.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22620.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 23350.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15323.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18971.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24079.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 20431.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14593.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15288.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14301.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14593.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21161.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15761.33, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20869.16, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12080.0, "minimum": 8550.0, "maximum": 19932.4455, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18120.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18120.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13288.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12080.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11476.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12442.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12080.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19932.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15704.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15100.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12805.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12684.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12684.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18724.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19328.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12684.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15704.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19932.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16912.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12080.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14730.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11838.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12080.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17516.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12080.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13046.69, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17274.79, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ANTERIOR COLPORRHAPHY, REPAIR CYSTOCELE", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22861.43, "discounted_cash": 5000.0, "minimum": 987.61, "maximum": 22404.2014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6900.86, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5500.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7176.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8671.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9610.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9610.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4750.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1468.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1688.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7250.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40656.1, "discounted_cash": 5562.0, "minimum": 1756.34, "maximum": 39842.978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35031.3, "discounted_cash": 5562.0, "minimum": 1513.35, "maximum": 34330.674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22405.0, "minimum": 21285.5575, "maximum": 36993.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33608.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 33608.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24646.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27598.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33293.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36993.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36993.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21285.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23077.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 36969.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29127.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28007.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23750.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 23526.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 23526.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34729.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 35849.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23526.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 29127.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 36969.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 31368.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22304.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21957.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 32488.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24198.32, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 32040.37, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17074.8, "maximum": 33288.9305, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18418.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22219.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24688.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24688.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17074.8 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12453.0, "minimum": 7349.3883, "maximum": 20548.836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18680.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18680.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13699.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12032.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14516.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16129.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16129.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12453.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11831.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12827.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12453.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20548.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16189.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15567.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13201.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13076.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13076.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19303.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19926.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13076.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16189.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20548.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17435.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11307.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12204.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12453.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18058.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12453.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13450.15, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17808.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18778.0, "minimum": 10750.7, "maximum": 30984.954, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28168.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28168.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20656.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18778.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17839.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19342.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18778.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 30984.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24412.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23473.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19905.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19717.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19717.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29107.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30046.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19717.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24412.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30984.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26290.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18778.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10750.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18403.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18778.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27229.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20281.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26853.63, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Av Fusion/Forearm Vein", "code_information": [ { "code": "36820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40112.8, "discounted_cash": 5562.0, "minimum": 1732.87, "maximum": 39310.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43595.0, "minimum": 31950.0, "maximum": 89623.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 65393.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 65393.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 47954.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66862.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80661.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89623.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89623.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 43595.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41415.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 44903.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43595.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 71932.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56674.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54494.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46211.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 45775.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 45775.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 67572.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 69752.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 45775.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 56674.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 71932.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 61033.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43595.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59648.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42723.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 43595.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 63213.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43595.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47083.08, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 62341.48, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46522.0, "minimum": 43984.4, "maximum": 76762.7685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 69784.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 69784.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 51175.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 46522.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44196.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 47918.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46522.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 76762.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 60479.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58153.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49314.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 48849.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 48849.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 72110.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 74436.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 48849.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 60479.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 76762.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 65132.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46522.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43984.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 45592.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 46522.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 67458.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50244.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 66527.73, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15269.0, "minimum": 14505.55, "maximum": 25193.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22903.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22903.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16795.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17228.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20784.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23094.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23094.08 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14505.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15727.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25193.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19849.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19086.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16185.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16032.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16032.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23666.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24430.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16032.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19849.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25193.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21376.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18151.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14963.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22140.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15269.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16490.52, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21834.67, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21542.0, "minimum": 17454.0, "maximum": 35544.4485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32313.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 32313.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23696.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25935.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31287.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34764.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34764.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21542.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20464.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22188.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21542.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 35544.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28004.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26927.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22834.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22619.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22619.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33390.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34467.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22619.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 28004.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35544.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 30158.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21542.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17454.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21111.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21542.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31236.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21542.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23265.46, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30805.19, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42942.0, "minimum": 40795.451, "maximum": 74980.0, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46377.99, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 61407.89, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 64413.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 64413.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 47236.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 42942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40795.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 44230.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 70855.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55825.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53678.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45519.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 45089.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 45089.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 66561.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 68708.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 45089.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 55825.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 70855.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 60119.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58668.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42083.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 42942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 62266.77, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34138.6, "discounted_cash": 920.0, "minimum": 164.9088, "maximum": 33455.828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1270.58, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1012.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 164.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 199.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 220.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 220.86 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 874.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1288.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1150.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 975.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1427.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1288.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 893.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1335.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1841.42, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Breast Open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154.0, "discounted_cash": 3914.0, "minimum": 1046.0, "maximum": 24650.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5401.32, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4305.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5089.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6149.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3718.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4148.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5675.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 7828.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Av Fistula Revision", "code_information": [ { "code": "36833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46363.6, "discounted_cash": 5562.0, "minimum": 1900.0, "maximum": 45436.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13171.0, "minimum": 8079.3633, "maximum": 21732.9585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19757.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19757.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14488.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13956.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16836.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18707.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18707.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13171.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12512.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13566.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13171.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21732.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17122.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16464.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13830.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13830.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20415.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21074.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13830.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17122.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21732.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18440.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13171.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12694.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12908.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13171.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19098.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13171.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14225.21, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18835.23, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40854.5, "discounted_cash": 5562.0, "minimum": 1764.91, "maximum": 40037.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18238.0, "minimum": 14400.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27357.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 27357.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20062.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21542.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25988.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28876.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28876.08 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18238.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17326.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18785.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18238.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 30093.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23709.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22797.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19332.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19150.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19150.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 28269.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29181.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19150.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23709.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30093.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25533.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18238.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19514.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17873.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18238.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26445.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18238.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19697.25, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26080.61, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33915.5, "discounted_cash": 5562.0, "minimum": 1465.1496, "maximum": 33237.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7721.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9330.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10341.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29173.0, "minimum": 27714.7775, "maximum": 53588.23, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 30632.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 30632.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 45218.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 46677.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30632.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 37925.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48136.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 40842.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29173.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28895.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 28589.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 29173.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 42301.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31507.33, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 41718.03, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 43760.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 43760.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32090.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39978.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48229.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53588.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53588.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 29173.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27714.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30048.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29173.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29173.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 48136.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37925.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36466.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30923.91, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8663.0, "minimum": 4140.2, "maximum": 14294.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12995.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12995.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9529.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7763.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9365.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10406.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10406.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8230.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8923.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14294.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11262.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10829.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9183.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9096.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9096.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13428.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13861.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9096.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11262.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14294.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12128.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4140.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8490.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12561.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8663.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9356.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12388.6, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30741.0, "minimum": 19467.9466, "maximum": 52868.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 46112.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 46112.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 33816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39441.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47581.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52868.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52868.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29204.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 31664.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 50724.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39964.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38427.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32586.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 32279.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 32279.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 47649.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 49187.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 32279.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 39964.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 50724.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 43038.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28856.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 30127.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 44575.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30741.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33201.25, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 43960.92, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22405.0, "minimum": 13260.2392, "maximum": 36969.6525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33608.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 33608.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24646.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25655.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30950.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34389.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34389.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21285.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23077.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 36969.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29127.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28007.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23750.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 23526.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 23526.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34729.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 35849.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23526.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 29127.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 36969.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 31368.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17055.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21957.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 22405.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 32488.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22405.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24198.32, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 32040.37, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9037.0, "minimum": 3411.64, "maximum": 16343.0409, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13556.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13556.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9941.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8179.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9867.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10963.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10963.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8585.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9308.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14912.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11748.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11297.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9579.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14008.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14460.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11748.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14912.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12652.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3411.64 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8856.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13104.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9037.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9760.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12923.84, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12263.0, "minimum": 7027.226, "maximum": 20235.303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18395.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18395.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13490.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14106.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17017.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18908.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18908.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12263.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11650.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12631.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12263.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20235.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15942.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15329.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12999.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12876.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12876.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19008.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19622.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12877.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15942.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20235.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17169.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12263.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12272.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12018.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12263.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17782.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13244.93, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17537.26, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22987.0, "minimum": 9900.0, "maximum": 46376.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 34481.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 34481.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 25286.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34598.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41739.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46376.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46376.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 22987.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21838.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23677.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22987.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 37929.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29883.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28734.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24366.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 24136.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 24136.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 35630.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 36779.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24136.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 29883.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 37929.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 32182.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22987.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20808.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22527.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 22987.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 33331.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24826.46, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 32872.07, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10831.0, "minimum": 6405.58, "maximum": 20179.451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16247.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16247.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11914.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10625.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12818.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14242.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14242.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10831.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10289.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11156.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10831.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17871.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14080.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13539.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11481.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11372.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11372.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16788.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17330.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11372.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14080.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17871.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15163.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10831.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6405.58 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10614.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10831.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15705.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10831.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11697.92, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15488.92, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19512.0, "minimum": 18537.312, "maximum": 32196.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29269.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 29269.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21464.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23265.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28067.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31185.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31185.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18537.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20098.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 32196.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25366.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24391.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20683.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20488.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20488.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30245.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 31220.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20488.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25366.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32196.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 27318.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23724.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19122.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 28293.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19513.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21074.0, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 27903.53, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154.0, "discounted_cash": 3914.0, "minimum": 1046.0, "maximum": 24650.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5401.32, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4305.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5089.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6149.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3718.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4148.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5675.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 7828.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29506.0, "minimum": 28030.7, "maximum": 55305.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44259.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 44259.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32456.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41259.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49774.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55305.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55305.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28030.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30391.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 48684.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38357.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36882.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31276.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 30981.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 30981.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 45734.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 47209.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30981.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 38357.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48684.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 41308.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51073.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 28915.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 42783.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31866.48, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 42193.58, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28707.0, "minimum": 27271.669, "maximum": 49514.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 43060.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 43060.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 31577.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36939.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44562.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49514.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49514.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 28707.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27271.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 29568.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28707.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 47366.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37319.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35883.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30429.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 30142.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 30142.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 44495.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 45931.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30142.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 37319.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 47366.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 40189.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28707.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39116.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 28132.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 28707.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 41625.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28707.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31003.58, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 41051.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17221.0, "minimum": 14665.8, "maximum": 28414.8315, "payers_information": [ { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16360.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17737.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17221.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28414.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22387.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21526.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18254.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18082.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18082.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26692.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27553.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18082.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22387.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28414.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24109.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17221.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14665.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16876.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17221.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 24970.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18598.8, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24626.19, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25831.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25831.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18943.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19909.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24018.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17221.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26687.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26687.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17221.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9815.0, "minimum": 4870.51, "maximum": 16196.004, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14723.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14723.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10797.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8697.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10492.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11658.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11658.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9324.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10110.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16196.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12760.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12269.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10404.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10306.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15214.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15705.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10306.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12760.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16196.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13742.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4870.51 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9619.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14232.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9815.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10601.02, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14036.54, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37084.0, "minimum": 14850.0, "maximum": 61345.0902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 55627.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 55627.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 40793.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 37084.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35230.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 38197.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37084.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 61189.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 48210.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46356.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39309.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 38939.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 38939.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 57481.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 59335.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38939.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 48210.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 61189.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 51918.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37084.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46915.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 36343.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 37084.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 53772.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37084.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40051.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 53031.29, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17726.0, "minimum": 9900.0, "maximum": 29248.5765, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26589.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26589.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19499.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19109.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23053.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25614.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25614.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17726.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16840.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18258.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17726.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29248.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23044.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22158.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18789.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18612.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18612.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27475.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28362.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18612.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23044.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29248.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24816.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17726.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26487.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17371.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17726.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25703.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19144.52, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25348.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8404.0, "minimum": 5850.0, "maximum": 13866.9795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12606.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12606.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9244.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7753.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9353.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10392.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10392.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7984.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8656.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13866.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10925.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10505.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8908.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8824.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8824.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13026.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13446.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8824.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10925.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13866.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11765.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6846.92 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8236.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12186.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9076.57, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12018.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19249.0, "minimum": 15300.0, "maximum": 31761.6915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28874.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28874.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21174.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20074.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24217.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26908.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26908.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19249.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18287.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19826.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19249.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31761.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25024.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24061.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20404.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20211.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20211.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29836.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30799.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20211.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25024.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31761.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26949.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19249.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28002.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18864.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19249.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27911.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20789.47, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 27526.8, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7116.0, "minimum": 4293.45, "maximum": 11742.225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10674.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 10674.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7828.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5372.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6480.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7200.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7200.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6760.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7330.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 11742.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9251.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8895.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7543.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 7472.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 7472.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11030.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 11386.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7472.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 9251.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11742.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 9963.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4293.45 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 6974.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 10318.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7116.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7685.82, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 10176.6, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26457.0, "minimum": 19681.0993, "maximum": 47219.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 39686.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 39686.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29103.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35227.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42497.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47219.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47219.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 26457.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25134.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27251.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26457.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 43655.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34394.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33072.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28045.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 27780.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 27780.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 41009.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 42332.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27780.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 34394.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 43655.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 37040.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26457.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27269.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 25928.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 26457.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 38363.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26457.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28574.24, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 37834.41, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17448.0, "minimum": 13500.0, "maximum": 29371.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26172.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26172.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19193.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21912.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26434.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29371.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29371.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16576.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17972.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28790.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22683.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21810.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18495.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18321.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18321.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27045.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27917.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18320.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22683.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28790.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24427.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24292.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17099.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25300.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18844.44, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24951.44, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9136.0, "minimum": 4648.97, "maximum": 15074.8455, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13704.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13704.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10049.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8246.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9948.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11053.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11053.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8679.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9410.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15074.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11877.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11420.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9684.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9593.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9593.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14161.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14618.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9593.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11877.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15074.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12790.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4648.97 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8953.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13247.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9136.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9867.17, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13064.87, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27254.0, "minimum": 18400.2365, "maximum": 52866.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40881.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 40881.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29979.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39440.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47580.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52866.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52866.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 27254.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25891.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28072.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27254.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 44969.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35430.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34068.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28889.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 28617.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 28617.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 42244.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 43607.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28617.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 35430.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 44969.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 38156.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27254.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51737.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 26709.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 27254.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 39519.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29434.81, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 38973.86, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12507.0, "minimum": 6831.5927, "maximum": 20636.7315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18760.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18760.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13757.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13197.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15920.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17689.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17689.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12507.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11881.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12882.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12507.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20636.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16259.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15633.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13132.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13132.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19386.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20011.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13132.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16259.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20636.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17509.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8398.62 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12256.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12507.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18135.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13507.68, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17885.17, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15572.0, "minimum": 9000.0, "maximum": 33695.6054, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23359.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23359.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17130.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18795.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22675.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25194.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25194.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15572.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14794.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16039.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15572.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25695.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20244.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19466.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16507.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16351.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16351.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24137.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24916.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16351.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20244.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25695.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21801.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15572.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14753.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15261.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15572.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22580.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15572.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16818.58, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22269.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7915.0, "minimum": 3949.3, "maximum": 13060.542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11873.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 11873.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8707.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6144.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7412.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8236.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8236.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7519.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8152.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13060.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10290.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9894.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8390.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8100.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8311.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8311.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12268.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 12664.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8311.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10290.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13060.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11081.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3949.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7757.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 11477.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7915.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8548.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11319.14, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Bx Of Cervix W/Scope Leep", "code_information": [ { "code": "57460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 3235.0, "minimum": 334.068, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 334.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 403.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 447.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 447.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 74257.0, "minimum": 48150.0, "maximum": 153843.98, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 106188.45, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 111386.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 111386.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 81683.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 114772.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 138459.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 153843.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 153843.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 74257.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70544.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 76485.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 74257.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 122525.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 96534.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 92822.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 78713.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 77970.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 77970.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 115099.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 118812.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 77970.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 96534.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 122525.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 103960.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 74257.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100505.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 72772.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 74257.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 107673.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 74257.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 80198.27, "additional_payer_notes": "108.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51169.0, "minimum": 10350.0, "maximum": 84622.5443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 76754.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 76754.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 56286.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56595.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68275.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75862.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75862.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48611.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 52705.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 84430.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 66520.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 63962.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54240.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 53728.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 53728.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 79313.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 81871.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 53728.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 66520.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 84430.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 71637.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57827.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 50146.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 74196.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55263.54, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 73173.01, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42226.0, "minimum": 25200.0, "maximum": 79648.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 63339.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 63339.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 46449.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59420.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71683.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79648.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79648.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 42226.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40115.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 43493.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42226.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 69673.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54894.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52783.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44759.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 44337.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 44337.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 65450.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 67562.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 44337.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 54894.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 69673.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 59116.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42226.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45898.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 41381.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 42226.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 61228.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42226.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45604.49, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 60383.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15083.0, "minimum": 9000.0, "maximum": 24887.4285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22624.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22624.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16591.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17549.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21170.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23523.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23523.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15083.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14329.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15535.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15083.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24887.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19608.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18854.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15988.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15837.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15837.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23379.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24133.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15837.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19608.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24887.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21116.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15083.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20187.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14781.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15083.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21870.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15083.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16289.95, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21569.1, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17825.0, "minimum": 5400.0, "maximum": 29411.283, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26737.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26737.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19607.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20370.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24574.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27305.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27305.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17825.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16933.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18359.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17825.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29411.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23172.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22281.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18894.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18716.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18716.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27628.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28520.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18716.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23172.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29411.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24955.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17825.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19708.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17468.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17825.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25846.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19251.02, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25489.78, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19048.1, "discounted_cash": 3235.0, "minimum": 566.61, "maximum": 18667.138, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2022.87, "10th_percentile": 2022.87, "90th_percentile": 2022.87, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2092.19, "10th_percentile": 2092.19, "90th_percentile": 5437.47, "count": "1 through 10" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1988.78, "10th_percentile": 1988.78, "90th_percentile": 5168.71, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55165.0, "minimum": 37350.0, "maximum": 91023.1905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 82748.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 82748.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 60682.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 55165.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52407.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 56820.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55165.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 91023.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 71715.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 68957.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58475.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 57923.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 57923.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 85506.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 88264.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 57923.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 71715.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 91023.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 77231.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55165.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57024.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 54062.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 55165.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 79990.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55165.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59578.82, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 78886.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31702.0, "minimum": 21150.0, "maximum": 58625.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 47553.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 47553.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 34872.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43736.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52762.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58625.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58625.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 31702.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30117.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 32653.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31702.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 52308.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41212.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39627.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33604.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 33287.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 33287.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 49138.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 50723.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33287.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 41212.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 52308.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 44382.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31702.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37798.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 31068.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 31702.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 45968.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31702.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34238.29, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 45334.03, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 1952.0, "minimum": 893.76, "maximum": 20275.22, "payers_information": [ { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2732.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1893.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2830.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2537.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3904.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2693.77, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2147.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2888.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3490.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3868.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3868.54 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1854.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2010.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3220.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2732.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2440.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2069.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3025.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2537.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3220.82, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15183.0, "minimum": 7160.5681, "maximum": 25052.511, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22775.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22775.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16701.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16546.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19961.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22179.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22179.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15183.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14424.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15638.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15183.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25052.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19738.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18979.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16094.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15942.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15942.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23534.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24293.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15942.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19738.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25052.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21256.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14554.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14879.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15183.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22015.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15183.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16398.01, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21712.18, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10413.0, "minimum": 5509.8513, "maximum": 17182.968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15620.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15620.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11455.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9555.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11528.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12808.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12808.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10413.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9893.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10726.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10413.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17182.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13538.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13017.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11038.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10934.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10934.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16141.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16662.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10934.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13538.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17182.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14579.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10413.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7761.13 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10205.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10413.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15100.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10413.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11247.03, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14891.91, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47076.0, "minimum": 27900.0, "maximum": 77676.093, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 70614.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 70614.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 51784.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 47076.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44722.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 48488.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47076.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 77676.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 61199.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58845.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49900.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 49430.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 49430.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 72968.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 75322.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 49430.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 61199.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 77676.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 65906.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47076.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32991.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 46134.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 47076.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 68260.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50842.53, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 67319.28, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40120.0, "minimum": 13950.0, "maximum": 67146.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 60180.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 60180.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 44132.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50093.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60431.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67146.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67146.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 40120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38114.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 41323.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 66198.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52156.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50150.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42527.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 42126.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 42126.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 62186.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 64192.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 42126.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 52156.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 66198.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 56168.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38209.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 39317.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 40120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 58174.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40120.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43329.85, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 57371.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14071.0, "minimum": 8476.4697, "maximum": 23217.546, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21106.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21106.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15478.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15808.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19070.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21189.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21189.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14071.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13367.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14493.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14071.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23217.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18292.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17589.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14915.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14774.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14774.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21810.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22513.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14774.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18292.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23217.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19699.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11114.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13789.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14071.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20403.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15196.94, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20121.87, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18395.0, "minimum": 10800.0, "maximum": 35849.1088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27593.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 27593.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20235.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23330.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28145.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31272.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31272.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18395.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17476.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18947.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18395.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 30353.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23914.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22994.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19499.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19315.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19315.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 28513.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29433.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19315.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23914.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30353.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25754.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18395.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17084.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18027.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18395.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26673.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19867.5, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26306.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51169.0, "minimum": 23400.0, "maximum": 95768.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 76754.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 76754.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 56286.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71446.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 86191.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 95768.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 95768.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48611.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 52705.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 84430.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 66520.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 63962.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54240.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 53728.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 53728.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 79313.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 81871.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 53728.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 66520.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 84430.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 71637.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45991.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 50146.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 51169.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 74196.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55263.54, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 73173.01, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15713.0, "minimum": 4774.0, "maximum": 25927.836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23570.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23570.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17285.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15713.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14928.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16185.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15713.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25927.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20427.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19642.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16656.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16499.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16499.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24356.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16499.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20427.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25927.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21999.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15713.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15399.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15713.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22785.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15713.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16970.95, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22470.79, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733503", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 9.15, "10th_percentile": 9.15, "90th_percentile": 456.55, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59109.0, "minimum": 38250.0, "maximum": 118812.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 88664.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 88664.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 65020.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88638.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 106931.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 118812.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 118812.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 59109.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56153.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 60882.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59109.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 97530.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 76842.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 73886.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62655.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 62064.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 62064.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 91619.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 94575.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 62064.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 76842.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 97530.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 82753.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59109.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66611.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 57927.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 59109.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 85708.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63838.13, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 84526.41, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10742.0, "minimum": 4774.0, "maximum": 17724.5475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16113.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16113.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11816.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10205.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11064.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17724.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13964.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13427.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11386.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11279.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11279.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16650.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11279.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13964.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17724.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15039.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8699.85 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10527.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15576.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10742.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11601.52, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15361.27, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733701", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 9.15, "10th_percentile": 9.15, "90th_percentile": 456.55, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22501.0, "minimum": 12732.7106, "maximum": 39381.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33752.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 33752.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24751.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29379.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35442.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39381.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39381.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 22501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21376.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23176.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 37127.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29252.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28127.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23851.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 23626.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 23626.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34877.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 36002.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23626.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 29252.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 37127.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 31502.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13655.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22051.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 22501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 32627.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24301.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 32177.27, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9023.0, "minimum": 5739.19, "maximum": 14888.379, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13534.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13534.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9925.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7931.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9568.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10631.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10631.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8572.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9293.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14888.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11730.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11279.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9564.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9474.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13986.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14437.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9474.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11730.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14888.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12632.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5739.19 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8842.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13083.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9023.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9745.12, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12903.26, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10109.0, "minimum": 5001.87, "maximum": 16680.576, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15164.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15164.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11120.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9296.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11214.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12460.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12460.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10109.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9603.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10412.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10109.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16680.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13142.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12636.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10715.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10614.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15669.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16175.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10614.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13142.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16680.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14153.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10109.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5001.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9907.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10109.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14658.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10918.2, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14456.5, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25046.0, "minimum": 11250.0, "maximum": 65000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 37570.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 37570.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27551.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33597.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40531.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45034.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45034.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 25046.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23794.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 25798.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25046.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 41327.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32560.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31308.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26549.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 26299.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 26299.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 38822.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 40074.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26299.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 32560.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 41327.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 35065.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24145.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 24545.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 25046.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 36317.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25046.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27050.57, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 35816.95, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29484.0, "minimum": 7358.0, "maximum": 53476.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44226.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 44226.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32432.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39895.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48128.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53476.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53476.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 29484.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28010.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30368.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29484.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 48649.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38329.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36855.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31253.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 30958.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 30958.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 45700.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 47175.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30958.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 38329.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48649.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 41278.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29484.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34056.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 28894.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 29484.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 42752.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31843.16, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 42162.71, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21413.0, "minimum": 7200.0, "maximum": 65000.0, "payers_information": [ { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21413.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20342.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22055.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21413.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 35331.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27837.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26766.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22698.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22483.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22483.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33190.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34261.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22483.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 27837.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35331.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 29978.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21413.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20631.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20984.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21413.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31049.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23126.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30620.95, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32119.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 32119.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23554.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27952.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33721.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37467.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37467.95 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21047.0, "minimum": 8550.0, "maximum": 34728.507, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31571.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 31571.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23152.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25717.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31025.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34472.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34472.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21047.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19995.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21679.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21047.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 34728.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27361.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26309.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22310.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22099.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22099.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 32623.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 33676.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22099.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 27361.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 34728.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 29466.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21047.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24073.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20626.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21047.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 30519.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21047.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22731.39, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30098.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733201", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 9.15, "10th_percentile": 9.15, "90th_percentile": 456.55, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11471.0, "minimum": 4774.0, "maximum": 18927.6615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17206.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17206.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12618.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11471.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10897.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11815.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11471.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18927.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14912.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14339.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12159.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12044.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12044.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17780.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12044.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14912.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18927.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16059.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11471.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8042.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11241.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11471.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16633.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11471.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12389.01, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16403.97, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 200 Mg/100Ml In D5W", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00409230001", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11879.0, "minimum": 4774.0, "maximum": 19601.076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17819.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17819.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13067.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11879.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11285.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12235.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11879.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19601.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15443.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14849.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12592.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12473.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12473.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18413.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12473.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15443.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19601.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16631.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11879.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11904.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11641.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11879.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17225.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11879.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12829.8, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16987.6, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8969.0, "minimum": 5821.5, "maximum": 14799.2955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13453.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13453.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9866.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6818.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8225.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9139.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9139.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8520.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9238.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11660.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11211.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9507.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9417.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13902.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14350.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9417.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11660.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12556.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5821.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8789.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13005.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8969.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9686.81, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12826.06, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38422.0, "minimum": 20316.6642, "maximum": 84063.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 57633.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 57633.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 42264.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62714.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75656.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 84063.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 84063.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 38422.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36501.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 39574.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38422.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 63396.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 49948.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48027.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40727.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 40343.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 40343.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 59554.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 61475.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40343.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 49948.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 63396.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 53791.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38422.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44553.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 37653.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 38422.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 55712.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41495.99, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 54943.76, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18865.0, "minimum": 13615.9, "maximum": 33317.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28298.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28298.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20752.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24855.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29985.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33317.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33317.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18865.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17922.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19431.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18865.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31128.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24525.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23582.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19997.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19809.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19809.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29242.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30185.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19809.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24525.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31128.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26412.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18865.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13615.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18488.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18865.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27355.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18865.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20375.13, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26978.18, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14233.0, "minimum": 9006.34, "maximum": 35651.8329, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21350.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21350.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15657.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16355.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19730.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21922.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21922.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14233.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13522.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14660.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14233.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23485.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18504.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17792.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15087.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14945.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14945.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22062.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22774.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14945.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18504.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23485.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19927.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9006.34 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13949.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14233.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20639.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15372.63, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20354.51, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21512.0, "minimum": 4774.0, "maximum": 35495.757, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32268.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 32268.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23663.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21512.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20436.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22157.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21512.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 35495.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27966.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26890.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22803.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22588.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22588.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33344.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22588.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 27966.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35495.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 30117.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21512.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12746.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21082.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21512.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31193.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21512.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23233.59, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30762.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13257.0, "minimum": 7913.49, "maximum": 21874.2975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19885.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19885.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14582.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14692.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17724.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19694.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19694.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13257.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12594.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13654.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13257.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21874.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17234.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16571.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14052.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13920.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13920.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20548.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21211.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13920.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17234.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21874.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18560.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13257.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7913.49 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12992.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13257.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19222.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13257.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14317.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18957.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10734.0, "minimum": 4774.0, "maximum": 17712.6675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16102.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16102.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11808.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6341.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7650.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8500.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10734.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10198.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11057.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10734.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17712.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13955.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13418.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11379.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11271.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11271.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16639.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11271.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13955.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17712.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15028.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10734.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6672.66 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10520.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10734.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15565.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10735.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11593.75, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15350.98, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14819.0, "minimum": 10955.6, "maximum": 24452.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22229.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22229.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16301.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16997.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20505.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22784.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22784.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14819.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14078.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15264.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14819.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24452.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19265.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18524.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15708.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15560.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15560.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22970.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 23711.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15560.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19265.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24452.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 20747.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14819.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10955.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14523.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14819.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21488.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14819.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16005.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21192.37, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "99999070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 9.15, "10th_percentile": 9.15, "90th_percentile": 456.55, "count": "1 through 10" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 314672.0, "minimum": 55350.0, "maximum": 550602.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 472008.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 472008.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 346139.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 410768.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 495542.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 550602.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 550602.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 314672.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 298938.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 324112.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 314672.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 519209.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 409073.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 393340.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 333552.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 330405.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 330405.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 487741.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 503475.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 330405.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 409073.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 519209.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 440541.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 314672.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 318067.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 308378.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 314672.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 456274.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 314672.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 339845.97, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 449981.23, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38597.0, "minimum": 31950.0, "maximum": 73997.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 57896.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 57896.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 42457.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55204.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66598.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73997.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73997.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 38597.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36667.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 39755.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38597.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 63686.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50177.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48247.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40913.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 40527.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 40527.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 59826.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 61756.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40527.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 50177.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 63686.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 54036.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38597.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38575.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 37825.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 38597.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 55966.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38597.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41685.68, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 55194.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65000.0, "maximum": 135605.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101166.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 122045.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 135605.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 135605.6 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17964.0, "minimum": 13108.9, "maximum": 29641.689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26946.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26946.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19761.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20721.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24998.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27775.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27775.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17964.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17066.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18503.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17964.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29641.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23354.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22455.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19042.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18862.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18862.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27845.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28743.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18862.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23354.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29641.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25150.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17964.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13108.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17605.37, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17964.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26048.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19401.83, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25689.46, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18974.0, "minimum": 7358.0, "maximum": 33566.58, "payers_information": [ { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24666.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31308.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26564.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18974.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20719.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18595.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18974.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27513.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20492.51, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 27133.61, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28461.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28461.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20872.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25041.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30209.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33566.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33566.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18974.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18025.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19543.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18974.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18974.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31308.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24666.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23718.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20112.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19923.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19923.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29410.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30359.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19923.28, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8795.0, "minimum": 5263.69, "maximum": 19280.1374, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13193.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13193.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9675.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7608.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9178.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10198.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10198.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8356.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9059.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14513.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11434.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10994.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9323.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9235.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9235.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13633.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14073.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9235.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11434.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14513.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12314.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5263.69 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8619.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12753.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9499.46, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12577.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15793.0, "minimum": 7358.0, "maximum": 26058.483, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23689.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23689.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17372.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19052.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22984.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25538.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25538.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15793.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15003.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16266.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15793.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26058.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20530.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19741.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16740.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16582.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16582.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24479.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25268.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16582.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20530.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26058.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22110.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15793.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16159.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15477.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15793.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22899.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15793.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17056.46, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22584.02, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18716.0, "minimum": 7358.0, "maximum": 30882.819, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28075.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28075.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20588.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22359.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26973.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29970.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29970.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18716.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17781.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19278.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18716.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 30882.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24331.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23396.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19839.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19652.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19652.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29011.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29946.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19652.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24331.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30882.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26203.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18716.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19660.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18342.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18716.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27139.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18716.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20214.21, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26765.11, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11748.0, "minimum": 9956.859, "maximum": 19384.926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17622.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17622.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12923.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11677.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14087.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15652.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15652.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11748.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11161.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12100.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11748.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19384.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15272.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14685.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12335.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18210.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18797.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12335.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15272.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19384.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16447.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11748.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13320.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11513.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11748.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17035.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11748.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12688.32, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16800.27, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9954.0, "minimum": 6381.93, "maximum": 29861.3995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14932.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14932.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10950.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11323.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13659.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15177.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15177.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9456.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10253.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16425.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12941.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12443.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10551.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10452.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15429.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15927.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10452.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12941.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16425.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13936.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6381.93 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9755.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14434.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9954.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10751.07, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14235.21, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13653.0, "minimum": 7358.0, "maximum": 22528.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20480.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20480.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15019.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15649.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18879.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20977.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20977.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13653.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12971.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14063.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13653.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22528.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17749.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17067.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14473.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14336.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14336.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21163.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21846.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14336.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17749.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22528.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19115.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13653.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19895.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13380.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13653.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19798.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13653.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14746.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19524.88, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONIZATION OF CERVIX - 57520 - ", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33997.6, "discounted_cash": 3235.0, "minimum": 1046.0, "maximum": 33317.648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1988.78, "10th_percentile": 1988.78, "90th_percentile": 5168.71, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27617.0, "minimum": 7358.0, "maximum": 55347.9, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28446.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27617.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 45569.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35903.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34522.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29275.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 28998.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 28998.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 42807.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 44188.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28998.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 35903.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 45569.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 38665.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27617.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26597.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 27065.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 27617.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 40046.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29827.4, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 39493.68, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 41426.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 41426.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30379.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41291.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49813.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55347.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55347.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 27617.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26237.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11813.0, "minimum": 7907.36, "maximum": 19493.001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17720.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17720.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12995.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12367.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14919.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16577.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16577.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11813.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11223.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12168.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11813.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19493.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15358.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14767.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12522.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12404.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12404.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18311.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18902.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12404.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15358.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19493.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16539.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11813.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7907.36 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11577.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11813.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17130.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11813.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12759.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16893.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 400 Mg/200Ml In D5W", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021011487", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12142.0, "minimum": 8138.7346, "maximum": 20035.7685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18214.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18214.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13357.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13277.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16017.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17797.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17797.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12142.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11535.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12507.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12142.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20035.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15785.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15178.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12871.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12750.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12750.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18821.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19428.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12750.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15785.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20035.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17000.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11005.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11900.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12142.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17607.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13114.32, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17364.33, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11543.0, "minimum": 8066.0, "maximum": 29825.0302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17314.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8066.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17314.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12697.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12654.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15266.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16962.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16962.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11543.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10966.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11889.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11543.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19046.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15006.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14429.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12235.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12120.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12120.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18469.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12120.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15006.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19046.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16160.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11543.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10614.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11312.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11543.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16737.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11543.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.75, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16506.9, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9859.0, "minimum": 7076.34, "maximum": 21280.4489, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14789.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14789.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10845.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9166.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11058.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12286.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12286.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9366.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10155.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16268.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12817.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12324.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10451.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10352.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15282.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15775.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10352.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12817.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16268.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13803.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7076.34 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9662.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14296.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9859.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10648.44, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14099.33, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9908.0, "minimum": 7035.19, "maximum": 16349.223, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14862.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14862.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10899.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9717.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11723.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13025.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13025.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9413.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10205.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16349.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12881.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12385.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10503.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10404.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10404.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15358.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15853.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10404.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12881.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16349.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13872.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7035.19 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9710.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14367.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9908.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10701.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14169.33, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8461.0, "minimum": 4384.51, "maximum": 13961.9865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12692.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12692.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9307.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7646.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9224.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10249.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10249.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8038.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8715.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13961.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11000.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10577.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8969.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8884.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13115.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13538.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8884.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11000.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13961.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11846.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4384.51 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8292.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12269.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8461.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9138.75, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12100.39, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11639.0, "minimum": 8791.79, "maximum": 19205.5875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17459.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17459.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12803.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11660.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14067.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15630.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15630.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11639.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11057.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11988.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11639.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19205.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15131.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14549.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12338.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12221.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12221.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18041.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18623.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12221.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15131.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19205.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16295.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11639.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8791.79 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11406.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11639.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16877.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11639.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12570.93, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16644.84, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58871.0, "minimum": 48778.0, "maximum": 114942.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 88306.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 88306.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 64758.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 85750.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 103448.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 114942.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 114942.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 58871.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55927.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 60637.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58871.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 97137.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 76532.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 73588.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62403.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 61814.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 61814.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 91250.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 94193.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 61814.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 76532.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 97137.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 82419.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58871.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68718.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 57693.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 58871.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 85363.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58871.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63580.82, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 84185.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19768.0, "minimum": 8066.0, "maximum": 32657.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29652.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8066.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 29652.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21745.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24363.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29392.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32657.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32657.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19768.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18780.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20361.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19768.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 32618.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25699.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24710.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20954.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20756.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20756.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30641.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 31629.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20756.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25699.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32618.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 27675.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19768.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17849.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19373.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19768.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 28664.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19768.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21349.97, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 28268.94, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 82112.0, "minimum": 56250.0, "maximum": 135486.252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 123169.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 123169.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 90324.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 82112.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 78007.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 84576.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 82112.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 135486.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 106746.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 102641.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 87039.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 86218.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 86218.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 127274.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 131380.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 86218.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 106746.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 135486.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 114958.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 82112.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 105889.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 80470.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 82112.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 119063.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 82112.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88681.91, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 117421.42, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47479.0, "minimum": 34200.0, "maximum": 86999.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 71219.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 71219.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 52227.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 64904.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78299.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 86999.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 86999.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 47479.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45105.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 48903.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47479.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 78341.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 61723.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59349.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50328.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 49853.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 49853.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 73593.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 75967.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 49853.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 61723.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 78341.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 66471.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47479.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59377.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 46529.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 47479.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 68845.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47479.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51277.87, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 67895.7, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11443.0, "minimum": 8838.2, "maximum": 18881.346, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17164.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17164.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12587.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11317.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13653.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15170.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15170.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10871.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11786.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18881.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14876.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14304.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12129.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14850.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12015.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12015.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17737.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18309.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12015.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14876.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18881.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16020.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8838.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11214.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16592.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12358.7, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16363.83, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18007.0, "minimum": 17107.4575, "maximum": 29712.9525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27011.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 27011.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19808.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20710.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24984.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27760.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27760.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18007.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17107.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18548.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18007.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29712.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23410.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22509.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19088.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 22050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18908.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18908.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27912.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28812.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18908.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23410.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29712.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25210.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18007.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17347.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17647.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18007.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26111.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19448.48, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25751.23, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11260.0, "minimum": 8205.09, "maximum": 18579.6765, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16890.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16890.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12386.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11206.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13519.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15021.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15021.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11260.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10697.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11598.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11260.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18579.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14638.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14075.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11936.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11823.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11823.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17453.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18016.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11823.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14638.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18579.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15764.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11260.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8205.09 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11035.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11260.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16327.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11260.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12161.24, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16102.39, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65000.0, "maximum": 89946.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67103.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80952.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89946.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89946.98 } ] } ] }, { "description": "CMBN ANT PST COLPRHY", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30312.57, "discounted_cash": 5000.0, "minimum": 1309.5, "maximum": 29706.3186, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1468.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1688.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7250.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6900.86, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5500.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7176.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8671.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9610.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9610.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4750.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52720.16, "maximum": 70667.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52720.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63600.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70667.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70667.25 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64519.0, "minimum": 48600.0, "maximum": 125230.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 96779.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 96779.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 70971.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 93426.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 112707.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 125230.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 125230.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 64519.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61293.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 66454.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64519.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 106457.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 83875.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80649.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 68390.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 67745.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 67745.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 100005.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 103231.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 67745.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 83875.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 106457.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 90327.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64519.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51877.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 63229.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 64519.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 93553.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 64519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69680.98, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 92262.78, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11055.0, "minimum": 6700.1972, "maximum": 18241.1955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16582.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16582.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12160.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11304.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13637.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15152.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15152.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11055.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10502.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11386.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11055.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18241.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14371.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13819.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11608.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11608.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17135.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17688.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11608.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14371.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18241.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15477.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11055.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7232.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10834.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11055.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16030.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11939.69, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15809.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17018.0, "minimum": 9755.3859, "maximum": 28081.086, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25528.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25528.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18720.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20185.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24351.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27057.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27057.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17018.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16167.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17529.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17018.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28081.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21273.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18039.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17869.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17869.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26379.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27230.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17869.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28081.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 23826.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17018.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12486.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16678.46, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17018.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 24677.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17018.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18380.35, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24336.94, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26220.0, "minimum": 13500.0, "maximum": 45105.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 39331.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 39331.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 28842.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33650.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40594.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45105.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45105.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 26220.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24909.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27007.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26220.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 43264.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34087.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32776.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27794.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 27531.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 27531.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 40642.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 41953.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27531.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 34087.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 43264.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 36709.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26220.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24871.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 25696.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 26220.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 38020.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28318.49, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 37495.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9766.0, "minimum": 7750.3879, "maximum": 16114.065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14649.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14649.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10742.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9406.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11347.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12608.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12608.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9277.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10059.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16114.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12695.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12207.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10352.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10254.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10254.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15137.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15625.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10254.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12695.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16114.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13672.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10912.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9570.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14160.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10547.39, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13965.52, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22000.0, "minimum": 7200.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33000.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 33000.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24200.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27639.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33344.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37049.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37049.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 22000.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20900.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22660.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22000.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 36301.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28600.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27500.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23320.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 23100.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 23100.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34100.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 35200.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23100.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 28600.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 36301.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 30800.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22000.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24829.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21560.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 22000.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31900.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22000.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23760.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 31460.87, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52281 - ", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 2089.0, "minimum": 696.816, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2883.66, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2298.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2976.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3596.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3985.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3985.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1985.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3029.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9603.0, "minimum": 5191.89, "maximum": 15845.643, "payers_information": [ { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15845.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12484.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12004.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10179.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10083.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10083.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14885.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15365.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10083.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12484.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15845.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13444.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5191.89 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9411.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13924.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10371.69, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13732.89, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14405.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14405.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10563.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8454.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10199.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11332.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11332.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9123.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9891.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9603.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52291.0, "minimum": 36625.279, "maximum": 92748.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 78437.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 78437.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 57520.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69193.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83473.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92748.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92748.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49676.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 53860.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 86280.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 67978.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 65364.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55428.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 54905.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 54905.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 81051.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 83666.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 54905.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 67978.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 86280.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 73207.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 87654.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 51245.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 75822.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52291.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56474.71, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 74776.7, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 2089.0, "minimum": 892.0, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2883.66, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2298.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2976.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3596.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3985.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3985.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1985.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3029.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13570.0, "minimum": 12892.431, "maximum": 22392.117, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20356.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20356.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14928.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16058.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19372.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21524.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21524.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13570.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12892.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13978.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13570.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22392.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17642.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16963.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14385.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14249.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14249.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21035.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21713.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14249.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17642.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22392.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18999.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13570.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13712.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13299.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13570.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19677.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14656.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19406.5, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52332 - ", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32389.04, "discounted_cash": 3523.0, "minimum": 1046.0, "maximum": 31741.2592, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4862.69, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3876.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6127.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6791.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6791.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3347.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5109.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45087.0, "minimum": 32850.0, "maximum": 83518.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 67631.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 67631.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 49596.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62307.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75167.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83518.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83518.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42833.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 46440.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 74394.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 58613.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56359.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47792.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 47341.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 47341.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 69885.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 72140.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 47341.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 58613.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 74394.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 63122.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55426.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 44185.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 65377.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45087.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48694.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 64475.27, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29913.7, "discounted_cash": 3235.0, "minimum": 1046.0, "maximum": 29315.426, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 5763.72, "10th_percentile": 5763.72, "90th_percentile": 5763.72, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 4162.01, "10th_percentile": 4162.01, "90th_percentile": 4162.01, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1988.78, "10th_percentile": 1988.78, "90th_percentile": 5168.71, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24730.3, "discounted_cash": 738.0, "minimum": 111.11, "maximum": 24235.694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1019.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 834.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1008.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1118.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1118.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1071.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 2903.0, "minimum": 119.91, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21704.0, "minimum": 11226.0422, "maximum": 36867.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32556.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 32556.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23874.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27504.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33180.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36867.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36867.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21704.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20618.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22355.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21704.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 35811.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28215.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27130.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23006.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22789.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22789.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33641.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34726.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22789.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 28215.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35811.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 30385.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21704.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21225.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21269.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21704.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31470.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23440.37, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 31036.79, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33991.0, "minimum": 26100.0, "maximum": 60191.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 50987.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 50987.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 37391.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44905.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54172.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60191.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60191.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 33991.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32292.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35011.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33991.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 56086.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44189.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42489.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36031.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 35691.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 35691.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 52687.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 54386.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 35691.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 44189.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 56086.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 47588.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33991.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42799.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33311.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 33991.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 49288.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33991.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36711.17, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 48608.3, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43161.0, "minimum": 36450.0, "maximum": 78431.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 64742.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 64742.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 47477.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58512.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70588.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78431.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78431.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41003.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 44456.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 71216.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56109.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53951.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45751.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 45319.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 45319.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 66900.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 69058.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 45319.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 56109.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 71216.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 60425.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56362.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42298.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 62584.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43161.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46614.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 61720.8, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "D & C After Delivery", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 3235.0, "minimum": 696.816, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1303.05, "10th_percentile": 1303.05, "90th_percentile": 1303.05, "count": "1 through 10" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8940.0, "minimum": 5103.45, "maximum": 21096.3982, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13410.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13410.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9834.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7216.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9673.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9673.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8493.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9208.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14751.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11622.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11175.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9476.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9387.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13857.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14304.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9387.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11622.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14751.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12516.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5103.45 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8761.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12963.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8940.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9655.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12784.89, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46083.0, "minimum": 36450.0, "maximum": 88945.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 69124.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 69124.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 50691.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66356.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80050.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88945.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88945.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 46083.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43778.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 47465.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46083.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 76037.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 59908.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57603.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48848.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 48387.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 48387.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 71428.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 73732.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 48387.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 59908.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 76037.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 64516.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46083.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52955.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 45161.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 46083.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 66820.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46083.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49769.74, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 65898.82, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31998.0, "minimum": 17550.0, "maximum": 58004.38, "payers_information": [ { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 49597.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 51197.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33598.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 41598.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 52797.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 44798.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31998.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34135.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 31358.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 31998.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 46398.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34558.57, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 45758.11, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 47998.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 47998.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 35198.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43273.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52203.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58004.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58004.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 31998.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30398.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 32958.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31998.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 52797.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41598.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39998.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33918.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 33598.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 33598.64, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6170.722, "maximum": 18910.98, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14108.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17019.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18910.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18910.98 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11936.4 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34989.0, "minimum": 20700.0, "maximum": 57732.6255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 52484.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 52484.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 38488.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 34989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33240.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 36039.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 57732.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 45486.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43736.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37088.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 36738.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 36738.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 54233.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 55983.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36738.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 45486.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 57732.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 48985.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46314.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 34289.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 34989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 50734.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37788.63, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 50034.94, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26521.0, "minimum": 10350.0, "maximum": 54966.1354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 39782.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 39782.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29173.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 26521.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25195.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27317.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26521.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 43760.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34478.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33152.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28113.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 27847.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 27847.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 41108.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 42434.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27847.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 34478.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 43760.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 37130.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26521.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34911.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 25991.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 26521.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 38456.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26521.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28643.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 37926.02, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13166.0, "minimum": 12508.1275, "maximum": 21724.6425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19749.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19749.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14483.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13911.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16782.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18646.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18646.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13166.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12508.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13561.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13166.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21724.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17116.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16458.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13956.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13824.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13824.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20408.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21066.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13824.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17116.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21724.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18433.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13166.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14149.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12903.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13166.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19091.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14219.77, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18828.02, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26949.0, "minimum": 12150.0, "maximum": 44466.279, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40423.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 40423.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29644.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 26949.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25601.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27757.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26949.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 44466.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35034.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33686.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28566.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 28296.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 28296.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 41771.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 43118.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28296.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 35034.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 44466.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 37728.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26949.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27819.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 26410.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 26949.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 39076.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26949.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29105.2, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 38537.44, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Deliver Placenta", "code_information": [ { "code": "59414", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 3235.0, "minimum": 157.68, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23623.2, "discounted_cash": 5359.0, "minimum": 1020.52, "maximum": 23150.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8039.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7396.57, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5895.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7109.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8590.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9521.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9521.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5091.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5520.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8039.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7503.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6699.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5681.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7503.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5199.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1920.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2207.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7771.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10719.66, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15388.0, "minimum": 13177.2, "maximum": 25391.0085, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23082.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23082.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16927.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15949.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19240.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21378.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21378.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15388.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14619.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15850.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15388.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25391.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20005.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16311.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16157.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16157.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23852.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24621.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16157.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20005.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25391.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21543.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15388.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13177.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15080.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15388.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22313.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16619.57, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22005.54, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18590.0, "minimum": 11071.2875, "maximum": 30673.7805, "payers_information": [ { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23237.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19705.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 19519.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 19519.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 28814.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29744.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19519.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24167.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30673.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26026.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18590.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13348.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18218.37, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 18590.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26955.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20077.38, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 26583.94, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27885.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 27885.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20449.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19741.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23815.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26461.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26461.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 18590.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17660.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19147.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18590.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18590.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 30673.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24167.22, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36568.0, "minimum": 29250.0, "maximum": 66252.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 54852.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 54852.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 40224.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49426.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59627.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66252.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66252.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34739.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 37665.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 60337.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47538.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45710.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38762.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 38396.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 38396.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 56680.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 58508.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38396.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 47538.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 60337.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 51195.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37412.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 35836.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 53023.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36568.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39493.44, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 52292.24, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4429.4883, "maximum": 14474.18, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10798.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13026.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14474.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14474.18 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7677.06 } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.2%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338007704", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 16.5, "10th_percentile": 15.0, "90th_percentile": 1378.7, "count": "1 through 10" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31525.3, "discounted_cash": 697.0, "minimum": 652.0, "maximum": 30894.794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1045.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 961.92, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 766.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 934.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1129.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1252.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1252.19 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 662.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1045.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1150.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 871.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1080.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1150.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 975.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 676.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1010.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1394.08, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12028.0, "minimum": 3809.19, "maximum": 19846.926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18042.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18042.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13231.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12880.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15538.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17264.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17264.88 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11427.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12389.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19846.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15636.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15035.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12750.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12629.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12629.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18644.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19245.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12629.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15636.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19846.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16839.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3809.19 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11787.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17441.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12990.72, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17200.67, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20562.0, "minimum": 19534.318, "maximum": 33928.026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 30843.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 30843.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22618.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24069.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29036.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32262.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32262.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 20562.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19534.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21179.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20562.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 33928.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26731.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25703.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21796.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 21590.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 21590.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 31871.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 32899.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21590.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 26731.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 33928.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 28787.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21187.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20151.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 20562.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 29815.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20562.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22207.44, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 29404.29, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8312.0, "minimum": 4015.86, "maximum": 14719.6476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12468.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12468.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9143.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6704.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8088.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8987.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8987.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7896.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8561.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13714.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10805.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10390.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8810.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8727.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8727.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12883.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13299.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8727.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10805.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13714.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11636.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4015.86 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8145.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12052.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8312.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8977.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11886.29, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10389.0, "minimum": 7186.68, "maximum": 27817.004, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15584.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15584.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11428.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9783.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11802.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13114.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13114.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10389.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9869.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10701.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10389.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17142.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13506.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12986.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11012.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10908.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10908.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16103.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16623.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10908.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13506.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17142.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14545.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10389.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7186.68 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10181.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10389.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15064.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11220.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14856.91, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34197.8, "discounted_cash": 6043.0, "minimum": 1477.34, "maximum": 33513.844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9064.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8339.77, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6647.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8120.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9812.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10875.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10875.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5741.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 6224.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9064.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9971.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8460.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7554.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6405.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 5597.99, "10th_percentile": 5597.99, "90th_percentile": 5597.99, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9367.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9971.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8460.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5862.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1920.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2207.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8762.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 9179.81, "10th_percentile": 9179.81, "90th_percentile": 9179.81, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 12086.62, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16198.0, "minimum": 14153.6, "maximum": 49393.9178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24297.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 24297.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17818.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17302.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20873.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23192.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23192.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15388.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16684.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26727.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21057.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20247.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17170.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17008.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17008.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25107.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25917.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17008.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 21057.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26727.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22677.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14153.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15874.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23487.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16198.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17494.13, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23163.53, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15574.0, "minimum": 14296.3, "maximum": 25698.6015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23362.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23362.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17132.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17565.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21190.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23545.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23545.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15574.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14796.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16042.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15574.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25698.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20247.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19468.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16509.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16353.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16353.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24141.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24919.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16353.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20247.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25698.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21804.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15574.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14296.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15263.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15574.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22583.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15574.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16820.9, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22272.12, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.45%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338008503", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 16.5, "10th_percentile": 15.0, "90th_percentile": 1378.7, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11718.0, "minimum": 7692.82, "maximum": 19335.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17577.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 17577.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12890.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11849.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14294.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15882.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15882.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11132.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12069.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 19335.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15233.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14647.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12421.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8905.45, "10th_percentile": 8905.45, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12304.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12304.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18163.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18749.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12304.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15233.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19335.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 16405.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7692.82 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11483.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16991.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12655.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16757.03, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10613.0, "minimum": 4017.6, "maximum": 18000.0, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11462.37, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15177.03, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15919.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15919.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11674.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10613.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10082.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10931.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10613.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17511.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13797.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13266.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11250.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11143.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16450.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16981.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11143.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13797.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17511.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14858.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10613.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4017.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10401.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10613.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10613.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15389.29, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10291.0, "minimum": 5545.67, "maximum": 16981.0575, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15437.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15437.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11320.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9676.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11674.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12971.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12971.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10291.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9776.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10600.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10291.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16981.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13379.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12864.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10908.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10806.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10806.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15951.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16466.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10806.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13379.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16981.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14408.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10291.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5545.67 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10085.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10291.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14922.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10291.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11114.87, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14716.92, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14182.0, "minimum": 8722.7146, "maximum": 23400.4485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21273.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21273.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15600.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15127.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18249.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20276.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20276.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14182.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13472.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14607.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14182.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23400.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18436.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17727.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15033.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14891.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14891.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21982.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22691.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14891.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18436.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23400.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19854.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14182.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9364.49 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13898.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14182.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20564.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14182.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15316.66, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20280.39, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10493.0, "minimum": 7778.64, "maximum": 17314.803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15740.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15740.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11543.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9850.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11883.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13204.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13204.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10493.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9969.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10808.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10493.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17314.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13641.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13117.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11123.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11018.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11018.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16265.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16790.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11018.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13641.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17314.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14691.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10493.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7778.64 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10283.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10493.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15216.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11333.33, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15006.16, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25361.3, "discounted_cash": 3235.0, "minimum": 1046.0, "maximum": 24854.074, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 4791.24, "10th_percentile": 4791.24, "90th_percentile": 4791.24, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9895.0, "minimum": 6673.53, "maximum": 16327.839, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14843.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14843.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10885.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9291.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11209.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12454.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12454.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9400.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10192.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16327.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12864.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12369.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10489.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10390.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10390.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15338.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15833.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10390.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12864.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16327.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13853.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6673.53 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9697.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14348.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9895.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10687.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14150.79, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15867.0, "minimum": 11726.2, "maximum": 26182.002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23801.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23801.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17454.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18363.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22153.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24614.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24614.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15867.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15074.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16343.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15867.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26182.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20628.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19834.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16819.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16661.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16661.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24595.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25388.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16661.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20628.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26182.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22215.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15867.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11726.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15550.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15867.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23008.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15867.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17137.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22691.07, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18409.5, "discounted_cash": 306.0, "minimum": 52.1472, "maximum": 18041.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 423.44, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 337.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69.84 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 291.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 429.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 429.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 297.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 444.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10788.0, "minimum": 8166.56, "maximum": 17801.751, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16183.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16183.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11867.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10251.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12366.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13741.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13741.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10788.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10249.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11112.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10788.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17801.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14025.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13486.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11436.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14400.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11328.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11328.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16722.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17262.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11328.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14025.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17801.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15104.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10788.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8166.56 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10573.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10788.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15643.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10788.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11652.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15428.18, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12992.0, "minimum": 10650.9, "maximum": 21438.417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19489.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19489.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14292.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14317.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17272.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19191.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19191.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12992.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12343.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13382.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12992.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21438.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16890.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16241.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13772.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13642.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13642.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20139.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20788.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13642.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16890.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21438.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18190.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10650.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12733.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12992.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18839.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12993.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14032.42, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18579.96, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12547.0, "minimum": 10049.3, "maximum": 20703.243, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18821.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18821.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13802.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13258.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15995.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17772.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17772.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12547.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11920.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12923.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12547.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20703.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16311.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15684.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13300.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13174.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13174.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19448.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20075.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13174.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16311.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20703.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17566.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12547.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10049.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12296.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12547.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18193.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13551.21, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17942.81, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16758.0, "minimum": 15836.6, "maximum": 27784.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25138.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25138.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18434.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20728.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25006.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27784.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27784.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16758.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15921.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17261.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16758.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 27652.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21786.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20948.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17764.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17596.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17596.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25976.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 26814.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17596.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 21786.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 27652.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 23462.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16758.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15836.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16423.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16758.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 24300.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16759.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18099.71, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23965.36, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19235.0, "minimum": 18273.364, "maximum": 31737.948, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20196.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20196.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29814.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30776.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20196.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25005.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31737.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26929.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19235.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19026.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18850.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19235.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27890.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20773.93, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 27506.22, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28852.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28852.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21158.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22755.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27451.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30501.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30501.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19235.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18273.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19812.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19235.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19235.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31737.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25005.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24043.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20389.21, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8877.0, "minimum": 5259.31, "maximum": 14647.281, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13315.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13315.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9764.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7293.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8798.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9776.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9776.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8433.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9143.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 14647.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11540.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11096.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9409.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9321.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9321.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13759.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14203.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9321.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11540.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14647.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12428.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5259.31 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8699.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12871.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8877.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9587.31, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 12694.31, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8313.0, "minimum": 5015.88, "maximum": 13717.3245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12470.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12470.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9144.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6667.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8043.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8937.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8937.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7897.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8562.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13717.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10807.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10391.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8812.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8729.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8729.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12885.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13301.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8729.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10807.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13717.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11638.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5015.88 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8147.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12054.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8313.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8978.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11888.35, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19081.0, "minimum": 7315.3228, "maximum": 31484.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28622.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 28622.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20989.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22372.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26989.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29988.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29988.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18127.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19654.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 31484.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24806.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23852.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20226.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20035.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20035.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29576.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30530.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20035.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 24806.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31484.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 26714.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12481.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18700.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 27668.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19081.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20608.34, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 27286.97, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17994.0, "minimum": 10734.9, "maximum": 29690.397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26991.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26991.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19793.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17994.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17094.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18534.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17994.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29690.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23392.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19073.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18893.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18893.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27890.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28790.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18893.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23392.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29690.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25191.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17994.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10734.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17634.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17994.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26091.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17994.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19433.71, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25731.68, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 156620.0, "minimum": 108450.0, "maximum": 280120.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 234930.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 234930.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 172282.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 208979.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 252108.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 280120.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 280120.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 156620.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 148789.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 161319.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 156620.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 258423.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 203606.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 195776.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 166018.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 164452.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 164452.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 242761.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 250592.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 164451.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 203606.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 258423.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 219268.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 156620.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 226401.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 153488.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 156620.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 227100.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 156621.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 169150.15, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 223967.33, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9795.0, "minimum": 5865.29, "maximum": 16162.7565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14693.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14693.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10775.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8981.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10835.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12038.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12038.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9305.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10089.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16162.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12734.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12244.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10383.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10285.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10285.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15183.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15672.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10285.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12734.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16162.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13713.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5865.29 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9599.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14203.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9795.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10579.26, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14007.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11218.0, "minimum": 7188.43, "maximum": 18510.789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16827.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16827.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12340.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11205.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13517.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15019.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15019.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11218.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10657.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11555.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11218.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18510.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14584.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14023.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11891.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11779.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11779.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17388.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17949.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11779.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14584.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18510.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15706.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11218.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7188.43 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10994.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11218.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16267.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11218.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12116.15, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16042.68, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15689.0, "minimum": 9976.325, "maximum": 25887.444, "payers_information": [ { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25887.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20396.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19611.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16630.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16473.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16473.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24318.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25102.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16473.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20396.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25887.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21965.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15689.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12982.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15375.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15689.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22749.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16944.51, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22435.78, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23534.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23534.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17258.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18302.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22080.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24533.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24533.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15689.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14904.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16160.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15689.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15689.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9370.0, "minimum": 4509.74, "maximum": 51814.1294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14056.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14056.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10308.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8448.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10192.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11325.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11325.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8902.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9652.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15462.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12182.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11713.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9839.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9839.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14524.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14993.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9839.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12182.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15462.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13119.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4509.74 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9183.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13587.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9370.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10120.59, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13400.42, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Rectal Abscess", "code_information": [ { "code": "45020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 2774.0, "minimum": 696.816, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3829.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3052.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3938.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4758.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5274.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5274.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2635.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2857.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4161.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4578.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3884.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3468.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2941.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4300.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3607.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4578.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3884.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2691.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4023.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3607.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5549.28, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9250.0, "minimum": 6725.2, "maximum": 15263.688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13876.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13876.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10175.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8093.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9763.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10848.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10848.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8788.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9528.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15263.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12025.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11563.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9805.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9713.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9713.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14338.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14801.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9713.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12025.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15263.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12951.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6725.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9065.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13413.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9250.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9990.78, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13228.53, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9452.0, "minimum": 5647.24, "maximum": 15596.229, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14178.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14178.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10397.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8411.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10147.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11274.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11274.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8979.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9735.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15596.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12287.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11815.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10019.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9924.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9924.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14651.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15123.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9924.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12287.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15596.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13233.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5647.24 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9263.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13705.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9452.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10208.44, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13516.73, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9578.0, "minimum": 7144.022, "maximum": 15804.0795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14367.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14367.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10536.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8652.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10438.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11597.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11597.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9099.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9865.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15804.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12451.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11972.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10152.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10057.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10057.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14846.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15325.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10057.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12451.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15804.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13409.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7783.02 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9386.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13888.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10344.49, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13696.87, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Evacuate Mole Of Uterus", "code_information": [ { "code": "59870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34150.3, "discounted_cash": 3235.0, "minimum": 1046.0, "maximum": 33467.294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47953.0, "minimum": 11700.0, "maximum": 104683.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 71929.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 71929.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 52748.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78097.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 94215.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 104683.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 104683.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 47953.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45555.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 49391.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47953.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 79122.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 62339.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59941.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50830.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 50350.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 50350.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 74327.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 76725.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 50350.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 62339.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 79122.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 67134.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47953.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36782.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 46994.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 47953.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 69532.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47953.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51789.39, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 68572.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face-Mm B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 707.0, "minimum": 69.377, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 976.85, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 778.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 207.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 250.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 277.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 277.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 672.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1026.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 } ] } ] }, { "description": "ENDOMET SAMPL,WWO ENDOCERVICAL SAMP,ANY", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 202.0, "minimum": 84.8904, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 222.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 84.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 102.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 113.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 113.69 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 303.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 282.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 252.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 214.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 313.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 262.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 282.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 196.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 293.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 202.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 262.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 404.18, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38109.0, "minimum": 3543.86, "maximum": 82613.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 57163.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 57163.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 41920.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61632.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 74351.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 82613.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 82613.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36203.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 39252.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 62880.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 49541.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47636.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40395.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 40014.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 40014.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 59069.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 60974.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40014.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 49541.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 62880.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 53352.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3543.86 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 37346.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 55258.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41157.83, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 54496.01, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30856.2, "discounted_cash": 1650.0, "minimum": 117.21, "maximum": 30239.076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 210.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 254.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 281.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 281.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37501.9, "discounted_cash": 2903.0, "minimum": 1046.0, "maximum": 36751.862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22156.1, "discounted_cash": 2903.0, "minimum": 957.14, "maximum": 21712.978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 2903.0, "minimum": 893.76, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 3190.23, "10th_percentile": 3190.23, "90th_percentile": 3190.23, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 1650.0, "minimum": 652.0, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 968.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1296.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1296.88 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face-Mm B9+Marg 2.1-3 Cm", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 1650.0, "minimum": 89.1462, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 229.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 277.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 307.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 307.76 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13424.0, "minimum": 7184.9006, "maximum": 22151.019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20137.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20137.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14767.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14577.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17585.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19539.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19539.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13424.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12753.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13827.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13424.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22151.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17452.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16781.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14230.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14096.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14096.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20808.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21479.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14096.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17452.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22151.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18794.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13424.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13434.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13156.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13424.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 19466.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13424.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14498.85, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19197.55, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg >4 Cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 2903.0, "minimum": 159.58, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 157522.0, "minimum": 69811.8891, "maximum": 259911.993, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 157522.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 259911.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 204779.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 196902.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 166973.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 165398.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 165398.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 244159.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 252035.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 165398.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 204779.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 259911.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 220531.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 157522.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 230586.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 154371.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 157522.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 228406.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 170124.21, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 225257.06, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 236283.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 236283.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 173274.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 157522.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 149646.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157522.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 162247.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9124.0, "minimum": 4360.87, "maximum": 17231.3335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13686.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 13686.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10036.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8109.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9783.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10870.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10870.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8667.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9397.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15054.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11861.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11405.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9671.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 9580.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 9580.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14142.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 14598.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9580.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 11861.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15054.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 12773.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4360.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8941.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13229.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9124.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9853.95, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13047.36, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXCISION OLECRANON BURSA", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19661.15, "discounted_cash": 3270.0, "minimum": 849.36, "maximum": 19267.927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4513.7, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3597.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4598.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5557.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6159.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6159.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3107.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4742.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Excision Vaginal Cyst/Tumor", "code_information": [ { "code": "57135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39874.8, "discounted_cash": 3235.0, "minimum": 1046.0, "maximum": 39077.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3559.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4196.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5071.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5620.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3074.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4692.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12969.0, "minimum": 9069.38, "maximum": 21400.401, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19454.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19454.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13693.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16519.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18354.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18354.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12969.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12321.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13359.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12969.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21400.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16860.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16212.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13748.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 17100.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000.0, "10th_percentile": 18000.0, "90th_percentile": 18000.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13618.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13618.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20103.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20751.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13618.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16860.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21400.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18157.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12969.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9069.38 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12710.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12969.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18806.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12969.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.54, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18547.01, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep 5 Cm/>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20016.3, "discounted_cash": 2903.0, "minimum": 864.7, "maximum": 19615.974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABD LES SC 3 CM>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31086.63, "discounted_cash": 2903.0, "minimum": 1046.0, "maximum": 30464.8974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1524.42, "10th_percentile": 1524.42, "90th_percentile": 1524.42, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABD LES SC < 3 CM", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72176.67, "discounted_cash": 1650.0, "minimum": 892.0, "maximum": 70733.1366, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Tum Deep < 2 Cm", "code_information": [ { "code": "21013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31360.5, "discounted_cash": 1650.0, "minimum": 537.18, "maximum": 30733.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 537.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 649.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 719.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 719.44 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15520.0, "minimum": 8550.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23280.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 23280.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17072.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18236.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22000.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24445.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24445.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15520.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14744.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15985.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15520.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25608.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20176.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19400.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16451.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16296.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16296.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24056.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24832.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16296.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 20176.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25608.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21728.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15520.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17545.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15209.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15520.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22504.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15520.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16761.83, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 22193.9, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5376.66, "discounted_cash": 1650.0, "minimum": 232.27, "maximum": 5269.1268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31513.9, "discounted_cash": 1650.0, "minimum": 1046.0, "maximum": 30883.622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2191.5, "10th_percentile": 2191.5, "90th_percentile": 2191.5, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21537.0, "minimum": 16682.362, "maximum": 37485.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32305.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 32305.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23690.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27965.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33737.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37485.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37485.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 21537.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20460.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22183.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21537.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 35536.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27998.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26921.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22829.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 22613.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 22613.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33382.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34459.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22613.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 27998.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35536.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 30151.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21537.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20814.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21106.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 21537.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 31228.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21537.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23260.01, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 30797.98, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34078.1, "discounted_cash": 1650.0, "minimum": 1046.0, "maximum": 33396.538, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29036.9, "discounted_cash": 1650.0, "minimum": 1046.0, "maximum": 28456.162, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2191.5, "10th_percentile": 2191.5, "90th_percentile": 2191.5, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc thighknee les sc 3 cm>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689.0, "discounted_cash": 2903.0, "minimum": 893.76, "maximum": 20275.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 4167.89, "10th_percentile": 4167.89, "90th_percentile": 4167.89, "count": "1 through 10" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23623.2, "discounted_cash": 2903.0, "minimum": 1020.52, "maximum": 23150.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 2.1-3cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15748.83, "discounted_cash": 707.0, "minimum": 209.7816, "maximum": 15433.8534, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 976.85, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 778.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 209.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 253.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 280.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 280.96 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 672.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1026.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc skn hdrdnt ax smplntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44171.47, "discounted_cash": 2903.0, "minimum": 1046.0, "maximum": 43288.0406, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4007.04, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3194.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3895.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4707.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5217.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2758.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 3672.52, "10th_percentile": 3672.52, "90th_percentile": 3672.52, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4210.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29585.8, "discounted_cash": 1650.0, "minimum": 892.0, "maximum": 28994.084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1014.38, "10th_percentile": 1014.38, "90th_percentile": 1014.38, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21422.6, "discounted_cash": 1650.0, "minimum": 892.0, "maximum": 20994.148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2278.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1816.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2305.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2786.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3088.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1568.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2067.47, "10th_percentile": 2067.47, "90th_percentile": 2067.47, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2393.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Explore Parathyroid Glands", "code_information": [ { "code": "60500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36006.6, "discounted_cash": 5917.0, "minimum": 1555.4851, "maximum": 35286.468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8876.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8166.37, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6509.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8148.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9846.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10913.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10913.69 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5621.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 6095.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8876.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9764.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8284.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7397.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6272.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 6213.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9172.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6213.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7692.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9764.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8284.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5740.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1920.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2207.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8580.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7692.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11835.32, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30580.3, "discounted_cash": 3914.0, "minimum": 1046.0, "maximum": 29968.694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5401.32, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4305.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5089.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6149.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6816.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3718.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5871.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4148.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1046.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5675.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 7828.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31871.0, "minimum": 11700.0, "maximum": 52587.612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 47806.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 47806.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 35058.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 31871.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30277.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 32827.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31871.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 52587.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41432.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39839.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33783.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 33464.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 33464.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 49400.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 50994.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33464.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 41432.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 52587.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 44619.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31871.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42057.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 31233.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 31871.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 46213.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31871.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34420.98, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 45575.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Excision Graft Extremity", "code_information": [ { "code": "35903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28771.5, "discounted_cash": 3156.0, "minimum": 1242.9288, "maximum": 28196.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4655.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5625.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6235.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6235.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1468.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1688.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 2.5 Mg/250Ml", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "70092109337", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16178.0, "minimum": 9000.0, "maximum": 37784.3964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24267.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 24267.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17795.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18209.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21967.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24408.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24408.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16178.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15369.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16663.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16178.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 26693.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21031.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20222.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17148.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 16987.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25076.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25884.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16987.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 21031.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26693.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 22649.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16178.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11121.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15854.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16178.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 23458.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16178.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17472.36, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23134.7, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00641602225", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37612.0, "minimum": 23928.5805, "maximum": 67965.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 56418.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 56418.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 41373.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50704.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61168.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67965.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67965.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 37612.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35731.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 38740.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37612.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 62060.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 48896.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47015.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39869.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 39493.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 39493.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 58299.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 60179.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 39493.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 48896.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 62060.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 52657.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37612.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49018.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 36860.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 37612.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 54537.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40621.42, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 53785.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27537.0, "minimum": 22050.0, "maximum": 48301.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 41306.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 41306.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30291.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36034.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43471.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48301.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48301.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 27537.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26160.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28363.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27537.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 45436.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35798.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34421.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29189.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 28914.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 28914.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 42682.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 44059.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28914.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 35798.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 45436.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 38552.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27537.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39905.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 26986.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 27537.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 39929.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27537.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29740.33, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 39378.4, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12301.0, "minimum": 5400.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18452.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 18452.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13532.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12533.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15120.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16800.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16800.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 12301.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11686.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12671.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12301.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 20298.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15992.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15377.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13040.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 12917.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 12917.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19068.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19683.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12917.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 15992.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20298.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 17222.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14336.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12055.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 12301.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 17837.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12302.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13286.13, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 17591.82, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14096.0, "minimum": 8715.9015, "maximum": 23259.126, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21144.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21144.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15506.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15493.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18691.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20768.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20768.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14096.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13391.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14519.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14096.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23259.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18325.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17620.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14942.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14801.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14801.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21849.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22554.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14801.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18325.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23259.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19735.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14096.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11395.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13814.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14096.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20439.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14096.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15224.16, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20157.91, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13826.0, "minimum": 6300.0, "maximum": 28297.5196, "payers_information": [ { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14656.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 14517.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 14517.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21431.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22122.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14517.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 17974.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22813.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 19357.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13826.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16885.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13549.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13826.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20048.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14932.63, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 19771.91, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20739.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 20739.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15209.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14836.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17898.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19887.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19887.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13826.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13135.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14241.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13826.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 22813.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17974.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17283.13, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14888.0, "minimum": 11322.3989, "maximum": 24566.751, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22333.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22333.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16377.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15992.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19292.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21436.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21436.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14888.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14144.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15335.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14888.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24566.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19355.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18611.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15782.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15633.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15633.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23077.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 23822.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15633.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19355.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24566.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 20844.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14888.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20390.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14591.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14888.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21588.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14888.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16080.06, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21291.18, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 1 Mg/100Ml (10 Mcg/Ml)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "09992408303", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "1 through 10" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33853.0, "minimum": 2223.6, "maximum": 55858.473, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 50780.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 50780.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 37238.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 33853.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32160.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 34869.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33853.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 55858.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44009.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42317.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35884.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 35546.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 35546.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 52473.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 54165.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 35546.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 44009.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 55858.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 47395.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33853.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40537.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33176.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 33853.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 49087.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36561.91, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 48410.68, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46622.0, "minimum": 6431.84, "maximum": 80550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 69933.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 69933.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 51284.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 46622.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44291.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 48020.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46622.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 76926.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 60608.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58277.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49419.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 48953.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 48953.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 72264.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 74595.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 48953.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 60608.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 76926.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 65271.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46622.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6431.84 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 45689.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 46622.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 67602.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46622.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50352.0, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 66669.77, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55470.0, "minimum": 30126.8, "maximum": 91525.5825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 83205.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 83205.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 61017.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 55470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52696.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 57134.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 91525.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72111.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 69337.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58798.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 58243.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 58243.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 85978.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 88752.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 58243.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 72111.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 91525.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 77658.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30126.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 54360.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 55470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 80431.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59907.65, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 79322.17, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16998.0, "minimum": 14834.9, "maximum": 28047.8385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25498.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25498.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18698.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19795.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23880.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26533.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26533.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16998.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16148.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17508.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16998.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28047.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22098.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21248.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18018.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 20250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 49500.0, "10th_percentile": 49500.0, "90th_percentile": 49500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17848.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17848.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26347.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27197.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17848.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22098.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28047.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 23798.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16998.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14834.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16658.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16998.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 24648.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18358.59, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24308.13, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16130.0, "discounted_cash": 1607.0, "minimum": 696.816, "maximum": 15807.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2218.2, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1768.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2277.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2751.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3049.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3049.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1527.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2330.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8378.0, "minimum": 5974.74, "maximum": 13824.2115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12567.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 12567.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9216.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7010.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8457.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9397.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9397.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7959.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8629.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 13824.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10891.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10472.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8881.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8797.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8797.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12986.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13405.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8797.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10891.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13824.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 11729.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5974.74 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8210.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 12148.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8378.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9048.57, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11980.98, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9525.0, "minimum": 5057.03, "maximum": 15717.372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14288.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14288.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10478.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9043.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10909.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12121.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12121.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9049.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9811.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15717.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12383.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11907.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10097.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10001.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10001.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14764.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15241.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10001.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12383.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15717.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13335.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5057.03 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9335.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13812.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9525.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10287.73, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13621.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14470.0, "minimum": 10957.3, "maximum": 23876.721, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21706.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 21706.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15917.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16635.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20069.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22299.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22299.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 14470.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13747.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14904.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14470.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 23876.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18811.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18088.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15338.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15194.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15194.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22429.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 23153.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15194.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 18811.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23876.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 20259.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14470.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10957.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14181.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 14470.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 20982.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15628.4, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 20693.16, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Cit 0.4 Mg/200Ml-Ropiv 0.1%-Nacl 0.9% Epidural Inj", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "70092120737", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17295.0, "minimum": 16430.4875, "maximum": 28537.1625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25942.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25942.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19024.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19520.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23548.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26165.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26165.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17295.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16430.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17814.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17295.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 28537.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22483.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21619.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18333.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18160.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18160.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26807.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27672.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18160.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 22483.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28537.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 24213.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17295.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16667.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16949.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17295.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 25078.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17295.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18678.87, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 24732.21, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23931.0, "minimum": 22734.564, "maximum": 39486.348, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 35896.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 35896.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 26324.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28926.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34895.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38773.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38773.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 23931.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22734.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 24649.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23931.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 39486.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31110.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29913.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25366.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 25127.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 25127.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 37093.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 38289.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25127.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 31110.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 39486.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 33503.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23931.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25724.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23452.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 23931.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 34700.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23931.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25845.61, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 34221.5, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00641602410", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 11.5, "10th_percentile": 11.5, "90th_percentile": 11.5, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16745.0, "minimum": 12555.5, "maximum": 27629.778, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25117.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 25117.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18419.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19520.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23548.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26165.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26165.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 16745.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15908.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17247.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16745.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 27629.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21768.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20931.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17750.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 17582.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 17582.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25955.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 26792.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17582.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 21768.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 27629.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 23443.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16745.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12555.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16410.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 16745.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 24280.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18084.95, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 23945.81, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10230.0, "minimum": 5530.78, "maximum": 16880.1105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15345.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15345.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11253.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9628.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11615.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12906.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12906.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10230.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9718.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10537.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10230.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16880.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13299.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12788.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10844.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10741.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15857.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16368.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10741.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13299.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16880.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14322.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10230.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5530.78 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10025.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10230.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14834.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10230.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11048.8, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14629.43, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9653.0, "minimum": 5580.69, "maximum": 15928.7865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14480.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14480.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10619.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8490.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10242.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11381.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11381.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9171.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9943.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15928.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12549.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12067.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10233.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10136.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10136.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14963.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15446.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10136.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12549.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15928.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13515.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5580.69 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9460.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13998.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9653.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10426.11, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13804.95, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27024.0, "minimum": 15256.9, "maximum": 44589.798, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40536.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 40536.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29726.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 27024.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25672.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27834.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27024.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 44589.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35131.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33780.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28645.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 28375.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 28375.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 41887.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 43238.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28375.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 35131.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 44589.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 37833.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27024.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15256.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 26483.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 27024.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 39184.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27024.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29186.05, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 38644.49, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9022.72, "discounted_cash": 12833.0, "minimum": 389.78, "maximum": 9022.72, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11199.0, "minimum": 8528.22, "maximum": 35122.8249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16798.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16798.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12319.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10940.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13198.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14664.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14664.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 11199.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10639.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11535.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11199.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 18478.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14559.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13999.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11871.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11759.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11759.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17358.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17918.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11759.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14559.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18478.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15678.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11199.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8528.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10975.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 11199.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 16238.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11199.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12095.17, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 16014.9, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9643.0, "minimum": 4546.51, "maximum": 15910.9665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14464.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 14464.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10607.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8677.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10468.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11631.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11631.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9160.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 15910.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12535.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12053.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10221.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10125.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10125.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14946.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15428.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10125.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 12535.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15910.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 13500.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4546.51 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9450.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 13982.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9643.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10414.45, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 13789.5, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.0, "minimum": 38.36, "maximum": 870.24, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3240.0, "minimum": 639.6883, "maximum": 14511.448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4861.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4472.22, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3564.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6189.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7463.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8292.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8292.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3078.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3337.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4861.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5347.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4537.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4050.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3435.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5023.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4212.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5347.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4537.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3143.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1920.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2207.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4699.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4212.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6481.48, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28740 - ", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9022.72, "discounted_cash": 7253.0, "minimum": 389.78, "maximum": 9022.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7978.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9022.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6890.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 9022.72, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10286.0, "minimum": 6440.61, "maximum": 17012.0156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15429.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 15429.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11315.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9582.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11559.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12844.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12844.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10286.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9772.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10595.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10286.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 16972.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13372.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12858.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10903.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 10800.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 10800.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15944.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16458.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10800.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 13372.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16972.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 14401.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6440.61 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10080.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10286.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 14915.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11109.43, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 14709.71, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7756.0, "minimum": 3747.89, "maximum": 12798.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11634.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 11634.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8532.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6410.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7734.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8593.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8593.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7368.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7989.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 12798.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10083.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9695.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8221.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 8144.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 8144.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12022.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 12410.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8144.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 10083.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12798.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 10858.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3747.89 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7601.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 11246.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7756.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8376.91, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 11091.65, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15125.0, "minimum": 7845.7713, "maximum": 24956.316, "payers_information": [ { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15125.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 21931.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16335.04, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21628.81, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22687.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22687.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16637.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15544.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18752.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20835.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20835.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15125.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14368.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15578.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15125.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 24956.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19662.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18906.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16032.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15881.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15881.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23443.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24200.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15881.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19662.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24956.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21175.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15125.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14821.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14822.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15125.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13068.0, "minimum": 7860.3708, "maximum": 21563.124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19602.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 19602.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14375.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13576.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16378.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18198.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18198.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 13068.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12415.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13460.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13068.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 21563.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16989.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16335.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13852.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 13722.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 13722.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20256.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20909.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13721.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 16989.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21563.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 18295.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13068.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12926.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12807.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 13068.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 18949.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13068.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14114.04, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 18688.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19752.0, "minimum": 3187.46, "maximum": 32591.889, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29628.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 29628.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21727.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 19752.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18765.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20345.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19752.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 32591.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25678.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24690.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20937.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 20740.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 20740.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30616.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 31604.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20740.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 25678.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32591.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 27653.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19752.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3187.46 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19357.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 19752.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 28641.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19752.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21332.87, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 28246.3, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15172.0, "minimum": 9950.0459, "maximum": 25034.691, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22758.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 22758.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16689.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17155.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20695.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22995.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22995.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 15172.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14413.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15627.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15172.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 25034.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19724.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18965.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16082.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 15931.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 15931.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23517.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24276.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15931.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 19724.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25034.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 21241.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15172.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13608.0 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14869.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 15172.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 22000.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16386.34, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 21696.73, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10899.0, "minimum": 7658.67, "maximum": 17984.6535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16349.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 16349.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11989.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10929.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13184.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14649.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14649.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 10899.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10354.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11226.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10899.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 17984.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14169.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13624.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11553.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 11444.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 11444.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16894.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17439.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11444.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 14169.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17984.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 15259.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10899.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7658.67 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10681.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 10899.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 15804.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10899.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11771.77, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 15586.7, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17979.0, "minimum": 14400.0, "maximum": 42312.9253, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26969.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "case rate", "standard_charge_dollar": 26969.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19777.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19738.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23812.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26458.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26458.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "case rate", "standard_charge_dollar": 17979.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17080.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18519.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17979.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "case rate", "standard_charge_dollar": 29666.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23373.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22474.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19058.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "case rate", "standard_charge_dollar": 18878.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "case rate", "standard_charge_dollar": 18878.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27868.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28767.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18878.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "case rate", "standard_charge_dollar": 23373.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29666.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "case rate", "standard_charge_dollar": 25171.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17979.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16303.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17620.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "case rate", "standard_charge_dollar": 17979.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "case rate", "standard_charge_dollar": 26070.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17979.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19418.16, "additional_payer_notes": "108.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "case rate", "standard_charge_dollar": 25711.09, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open Tx Metacarpal Fracture Single Ea Bone", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14883.3, "discounted_cash": 3270.0, "minimum": 642.9586, "maximum": 18297.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4513.7, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3597.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4598.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5557.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6159.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6159.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3107.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4742.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 0.86, "10th_percentile": 0.86, "90th_percentile": 0.86, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1.71, "10th_percentile": 1.71, "90th_percentile": 1.71, "count": "1 through 10" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 1.07, "count": "1 through 10" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 3.65, "10th_percentile": 3.65, "90th_percentile": 3.65, "count": "1 through 10" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 3.96, "10th_percentile": 3.96, "90th_percentile": 3.96, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1.12, "10th_percentile": 1.12, "90th_percentile": 1.12, "count": "1 through 10" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 1.07, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2.9, "10th_percentile": 1.45, "90th_percentile": 4.35, "count": "1 through 10" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 5.43, "10th_percentile": 5.43, "90th_percentile": 5.9, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 2.9, "10th_percentile": 1.45, "90th_percentile": 4.35, "count": "1 through 10" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 5.43, "10th_percentile": 5.43, "90th_percentile": 5.9, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1769) Guide Wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 422.6, "10th_percentile": 422.6, "90th_percentile": 422.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1751) Cath Infus Insrt Periph Cntrl/Midln", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.9, "discounted_cash": 783.0, "minimum": 74.0, "maximum": 4347.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1175.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1081.41, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 861.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1953.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2362.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.16 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 744.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 807.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1175.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1097.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 979.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 830.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1214.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1097.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 760.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1136.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1567.26, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3178.35, "discounted_cash": 238.0, "minimum": 74.0, "maximum": 3114.783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 262.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 278.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 336.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 226.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 357.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 393.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 333.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 298.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 252.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 697.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 533.63 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 369.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 657.7 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 310.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.43 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 393.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 333.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 231.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 638.76 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 345.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 657.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 515.61 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 310.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 477.02, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3178.35, "discounted_cash": 783.0, "minimum": 74.0, "maximum": 3114.783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1175.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1081.41, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 861.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1953.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2362.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.16 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 744.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 807.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1175.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1097.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 979.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 830.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1214.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1097.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 760.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1136.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1567.26, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.0, "minimum": 22.46, "maximum": 842.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.32 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3943.21, "discounted_cash": 906.0, "minimum": 170.3467, "maximum": 3864.3458, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1251.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 997.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1320.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1595.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1768.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1768.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 861.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 933.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1133.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 879.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1314.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16800.0, "discounted_cash": 7796.0, "minimum": 725.76, "maximum": 16464.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11695.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10759.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8576.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9887.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11947.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13242.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13242.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7406.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8030.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11695.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12864.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10915.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9746.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8264.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8186.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8186.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12085.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8186.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10135.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12864.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10915.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7562.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11305.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10135.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 15593.62, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.49, "discounted_cash": 200.0, "minimum": 15.27, "maximum": 353.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.76, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 220.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 293.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 190.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 280.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 250.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 210.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 280.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 290.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimj Panel 3 Beta-Hydroxydehyd Defncy", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.5, "discounted_cash": 78.0, "minimum": 46.96, "maximum": 1052.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 108.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 224.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 301.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 301.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 82.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.67 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.23 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.5 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.55 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 75.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 78.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 310.29 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 113.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.5 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.47 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 156.52, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86.0, "minimum": 52.18, "maximum": 1168.944, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 84.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 344.8 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 126.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.32 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 173.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.36 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 120.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 249.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 301.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 334.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 334.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 108.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.32 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.05 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.02 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.75 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 552.0, "discounted_cash": 15.0, "minimum": 9.19, "maximum": 540.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.3 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.75 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.55 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 60.75 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.55 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.03 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.33, "discounted_cash": 16.0, "minimum": 10.12, "maximum": 298.2434, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.88 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.71 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.88 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.99 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.34, "discounted_cash": 906.0, "minimum": 152.2083, "maximum": 3452.8732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1251.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 997.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1320.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1595.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1768.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1768.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 861.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 933.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1133.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1057.0, "10th_percentile": 1057.0, "90th_percentile": 1057.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 879.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 538.69, "10th_percentile": 538.69, "90th_percentile": 538.69, "count": "1 through 10" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1314.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.86, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 183.1228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000.0, "minimum": 344.0, "maximum": 17640.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1280.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1548.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1717.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1717.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 581.0, "discounted_cash": 6.0, "minimum": 4.19, "maximum": 569.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.19 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.48 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.33 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.0, "discounted_cash": 32.0, "minimum": 19.57, "maximum": 358.68, "payers_information": [ { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.16 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.62 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.33 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.02, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 93.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.59 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.15 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.04 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1021.0, "discounted_cash": 14.0, "minimum": 8.68, "maximum": 1000.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.67 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.91 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.2 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 57.35 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.29 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actigraphy Testing, 3-14 Day", "code_information": [ { "code": "95803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 58.0, "minimum": 11.8169, "maximum": 273.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 211.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 211.79 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 85.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.0, "discounted_cash": 13.0, "minimum": 8.06, "maximum": 288.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.74 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.52 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 53.29 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Renaltumor Cryo, Unilat Perq", "code_information": [ { "code": "50593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38708.2, "discounted_cash": 10625.0, "minimum": 1672.19, "maximum": 37934.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15938.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14663.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11688.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14134.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17078.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18929.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18929.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10094.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 10944.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15938.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17532.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14876.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13282.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11263.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 11157.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11157.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16470.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11157.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 13813.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17532.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14876.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10307.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2292.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 2637.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15407.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10625.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13813.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 21251.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.01, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 161.7098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.43, "discounted_cash": 64.0, "minimum": 38.65, "maximum": 482.5814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 88.89, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 223.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.33 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.93 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.25 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 62.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 255.35 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.93 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.12 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate/ Reconstuct Atria, W Othr Proced Limitd", "code_information": [ { "code": "33257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.79, "minimum": 23.1, "maximum": 534.79, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 534.79 } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.0, "discounted_cash": 12.0, "minimum": 7.72, "maximum": 370.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.63 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.54 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 51.02 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.19 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.68, "discounted_cash": 13.0, "minimum": 8.32, "maximum": 240.7664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.64 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.02 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.94 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.62 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.34 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 54.99 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.39 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholinesterase Assay", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.78, "discounted_cash": 12.0, "minimum": 7.37, "maximum": 214.4044, "payers_information": [ { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.69 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.16 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.39 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 48.71 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.32 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 24.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.96, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 46.0, "minimum": 7.99, "maximum": 185.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 64.58, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 148.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 185.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 185.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 72.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 67.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Ther Amniotic Fluid Reduct", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1391.43, "discounted_cash": 304.0, "minimum": 60.1098, "maximum": 1391.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1391.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1391.43 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.36, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 229.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 277.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 307.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 307.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 289.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 313.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 456.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 426.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 380.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 322.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 319.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 472.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 395.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 426.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 295.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 441.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 609.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.21, "discounted_cash": 12.0, "minimum": 6.92, "maximum": 51.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.91 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.77 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.56 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3337.84, "discounted_cash": 3270.0, "minimum": 144.19, "maximum": 3337.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3337.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3337.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3337.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3337.84 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3107.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3337.84, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 357.73, "discounted_cash": 16.0, "minimum": 9.64, "maximum": 350.5754, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.87 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.23 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.61 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.22 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 63.72 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.61 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.44 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.0, "discounted_cash": 46.0, "minimum": 9.1152, "maximum": 206.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 64.58, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.59 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 72.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 67.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.23, "discounted_cash": 7.0, "minimum": 4.78, "maximum": 117.8254, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.38 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.51 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.51 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.49 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12389.2, "discounted_cash": 3156.0, "minimum": 94.24, "maximum": 12141.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.97 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 642.94 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 792.42 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.55 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 769.6 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 792.42 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 621.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.0, "discounted_cash": 46.0, "minimum": 9.1152, "maximum": 206.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 64.58, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 137.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 166.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 72.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 65.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 67.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10624.0, "discounted_cash": 7.0, "minimum": 4.69, "maximum": 10411.52, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.85 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.93 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.44 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.93 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.11 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14160.0, "discounted_cash": 5562.0, "minimum": 101.74, "maximum": 14160.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.74 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13191.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14160.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14160.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14160.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 876.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 670.66 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 826.59 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 632.7 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 802.78 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 826.59 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 648.0 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 11.8195, "maximum": 268.128, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 87.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 106.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.0 } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.09, "discounted_cash": 17.0, "minimum": 10.2, "maximum": 202.9482, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.31 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.4 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 67.4 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.4 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.41 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12389.2, "discounted_cash": 3156.0, "minimum": 91.38, "maximum": 12141.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 774.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.9 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.34 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 709.7 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 572.87 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 829.01, "discounted_cash": 218.0, "minimum": 35.81, "maximum": 812.4298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 302.07, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 527.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 638.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 708.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 708.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 207.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 306.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 273.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 153.36, "10th_percentile": 20.98, "90th_percentile": 184.49, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 141.21, "10th_percentile": 20.98, "90th_percentile": 184.49, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 70.99, "10th_percentile": 45.33, "90th_percentile": 153.36, "count": "17" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 66.96, "10th_percentile": 19.78, "90th_percentile": 174.04, "count": "63" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 133.21, "10th_percentile": 42.74, "90th_percentile": 174.04, "count": "1 through 10" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 133.21, "10th_percentile": 133.21, "90th_percentile": 144.67, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 124.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 40.68, "10th_percentile": 40.68, "90th_percentile": 126.42, "count": "1 through 10" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 137.64, "10th_percentile": 137.64, "90th_percentile": 137.64, "count": "1 through 10" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 317.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 35.09, "10th_percentile": 35.09, "90th_percentile": 35.09, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 437.78, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.3, "discounted_cash": 95.0, "minimum": 27.96, "maximum": 634.354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 131.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 123.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 148.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 165.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 165.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 133.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 123.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 412.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 617.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 137.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 190.06, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.0, "discounted_cash": 14.0, "minimum": 8.76, "maximum": 515.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.34 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.58 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.61 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 57.87 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.71 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76 } ] } ] }, { "description": "Hc Albumin Ischemia Modified", "code_information": [ { "code": "82045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.92, "discounted_cash": 33.0, "minimum": 20.36, "maximum": 319.4016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.72 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.84, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 97.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 130.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 130.67 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.42 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.56 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.06 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 134.57 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.56 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 67.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10965.0, "discounted_cash": 3156.0, "minimum": 182.78, "maximum": 10745.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.52 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 941.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 720.74 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 888.31 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 679.94 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 862.72 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 888.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 696.39 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1196.0, "minimum": 192.1294, "maximum": 4358.4912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1794.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1650.76, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1315.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 358.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 433.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 480.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 480.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1136.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1232.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1794.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1674.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1495.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1267.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1854.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1674.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1160.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1734.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2392.4, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.2, "discounted_cash": 5.0, "minimum": 3.13, "maximum": 31.556, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.29 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.29 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.29 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.69 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8083.0, "discounted_cash": 3156.0, "minimum": 93.14, "maximum": 8083.0, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 631.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 495.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 669.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.54 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 631.7 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 483.53 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 613.51 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.42, "discounted_cash": 40.0, "minimum": 24.1, "maximum": 156.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.2 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 55.43, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 115.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 139.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.42 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.04 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.42 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.51 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 38.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 156.42 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 58.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.42 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.55 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 80.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1142.0, "discounted_cash": 133.0, "minimum": 49.33, "maximum": 1119.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.54, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 312.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 378.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 419.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 419.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 192.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 16.0, "minimum": 9.66, "maximum": 78.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.65 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.31 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.29 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 63.81 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.51 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.0, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 251.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.48, "discounted_cash": 16.0, "minimum": 10.12, "maximum": 147.4704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.88 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.71 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.88 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.99 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050.0, "discounted_cash": 64.0, "minimum": 38.51, "maximum": 1029.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.02 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 88.58, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 222.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.62 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.05 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 83.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.58 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 254.5 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 93.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.44 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.0, "discounted_cash": 8.0, "minimum": 5.19, "maximum": 1890.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.04 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 34.31 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 741.0, "discounted_cash": 22.0, "minimum": 13.79, "maximum": 726.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.58 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 79.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.47 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.43 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.8 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.8 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 91.1 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.53 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 325.0, "minimum": 195.48, "maximum": 846.0, "payers_information": [ { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 316.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 472.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 423.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 651.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 390.96 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 449.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 358.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 309.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 537.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 407.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 345.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 423.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 846.0 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 537.57, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.03, "minimum": 43.8493, "maximum": 994.7294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.68 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 110.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 122.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 122.08 } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "minimum": 1.0, "maximum": 325.8598, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.27 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.11 } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.85, "discounted_cash": 920.0, "minimum": 34.6399, "maximum": 801.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 801.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 801.85 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 110.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 133.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 147.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 147.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 170.0, "minimum": 3.43, "maximum": 250.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 22.66 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300.0, "minimum": 180.0, "maximum": 962.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 414.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 861.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 285.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 375.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 465.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 390.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 937.44 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 291.0, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 300.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 435.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 960.12 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 390.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 600.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 170.0, "minimum": 3.11, "maximum": 650.573, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 235.01, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 187.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 497.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 511.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 511.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 161.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.15 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 246.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.57 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniotic Fluid Scan", "code_information": [ { "code": "82143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.01, "discounted_cash": 9.0, "minimum": 5.61, "maximum": 114.6698, "payers_information": [ { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.95 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.15 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.2 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.06, "minimum": 43.8074, "maximum": 1014.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.6, "discounted_cash": 128.0, "minimum": 11.47, "maximum": 265.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 192.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 177.5, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 192.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 180.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 136.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 199.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 167.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 180.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 186.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 257.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.0, "discounted_cash": 10.0, "minimum": 6.11, "maximum": 245.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.19 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.05 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.71 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.55 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.81 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.55 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.58 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.0, "discounted_cash": 170.0, "minimum": 41.688, "maximum": 945.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 235.01, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 187.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 497.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 161.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 246.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.05, "minimum": 7.0, "maximum": 162.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 162.05 } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2713.26, "discounted_cash": 2062.0, "minimum": 117.21, "maximum": 2713.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2268.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2713.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2713.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2713.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2713.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1959.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 681.25, "discounted_cash": 12.0, "minimum": 7.25, "maximum": 667.625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.06 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.8 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,No Reprog", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 133.0, "minimum": 11.8169, "maximum": 273.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.54, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 192.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.0, "minimum": 52.79, "maximum": 1222.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1222.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1222.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.0, "discounted_cash": 215.0, "minimum": 34.99, "maximum": 793.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 297.86, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 237.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 273.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 330.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 366.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 366.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 302.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 269.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 228.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 334.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 302.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 209.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 312.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 431.68, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 508.0, "discounted_cash": 10.0, "minimum": 6.49, "maximum": 497.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.92, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.62 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.8 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.13 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.78 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 42.86 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.13 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.59 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5857.94, "discounted_cash": 3156.0, "minimum": 140.06, "maximum": 5857.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.06 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 889.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 681.19 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.57 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 642.63 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 815.38 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.57 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 658.18 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.3, "minimum": 35.91, "maximum": 831.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 425.0, "discounted_cash": 218.0, "minimum": 18.36, "maximum": 425.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 302.07, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 425.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 425.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 425.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 425.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 207.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 306.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 273.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 124.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 317.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 425.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13750.0, "discounted_cash": 504.0, "minimum": 302.4, "maximum": 13475.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 756.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.8 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 695.52, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 554.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1446.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1748.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1940.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1940.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 756.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 831.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 630.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 534.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.98 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1669.39 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2057.53 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 655.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.9 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 831.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 488.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 504.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 504.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 1998.26 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 730.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2057.53 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1613.0 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 655.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1008.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12389.2, "discounted_cash": 3156.0, "minimum": 85.64, "maximum": 12141.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.64 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 809.01 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 619.24 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.21 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.19 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 741.23 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.21 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 598.32 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.4, "discounted_cash": 133.0, "minimum": 92.4168, "maximum": 548.212, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 192.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.54, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 111.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 123.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 123.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.0, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 483.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7088.07, "discounted_cash": 738.0, "minimum": 306.2, "maximum": 6946.3086, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1019.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2726.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3294.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1071.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8083.0, "discounted_cash": 3156.0, "minimum": 94.68, "maximum": 8083.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 760.84 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 582.37 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 717.77 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.41 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 697.1 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 717.77 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 562.7 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.34, "discounted_cash": 133.0, "minimum": 41.802, "maximum": 139.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Resistance By Impulse Oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.0, "discounted_cash": 128.0, "minimum": 19.656, "maximum": 455.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 192.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 177.5, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 192.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 180.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 136.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 199.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 167.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 180.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 136.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 445.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 186.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 257.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7088.07, "discounted_cash": 738.0, "minimum": 306.2, "maximum": 6946.3086, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1019.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2726.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3294.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 775.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1219.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1034.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1071.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8083.0, "discounted_cash": 3156.0, "minimum": 91.38, "maximum": 12141.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 774.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.9 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.34 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 709.7 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 572.87 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 911.8, "discounted_cash": 133.0, "minimum": 126.35, "maximum": 893.564, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.54, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 183.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 221.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 245.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 245.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 192.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.69, "discounted_cash": 16.0, "minimum": 10.06, "maximum": 486.7562, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.56 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.56 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.41 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.5 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.68 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.5, "discounted_cash": 162.0, "minimum": 24.21, "maximum": 549.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 113.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 137.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 152.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 152.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1196.0, "minimum": 192.1294, "maximum": 4358.4912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1794.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1650.76, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1315.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 852.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1030.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1141.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1141.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1136.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1232.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1794.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1674.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1495.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1267.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1854.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1674.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1160.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1734.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2392.4, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12.0, "minimum": 3.615, "maximum": 12.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 14.0, "minimum": 8.51, "maximum": 191.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.59 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.96 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.88 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.31 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 56.22 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.88 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.38 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.4, "discounted_cash": 162.0, "minimum": 83.664, "maximum": 1168.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 112.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 112.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 42.0, "minimum": 20.325, "maximum": 67.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.4, "discounted_cash": 58.0, "minimum": 7.66, "maximum": 173.852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 85.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.08, "discounted_cash": 19.0, "minimum": 11.77, "maximum": 223.5184, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.85 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.94 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.04 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.27 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 77.74 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.75 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5714.24, "discounted_cash": 1607.0, "minimum": 246.8552, "maximum": 5599.9552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2218.2, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1768.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2277.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2751.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3049.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3049.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1527.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2330.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1960.0, "discounted_cash": 348.0, "minimum": 135.99, "maximum": 1920.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 523.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 481.26, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1095.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1325.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1470.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1470.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 575.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 488.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 435.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 369.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 366.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 700.57 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 536.24 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 540.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 660.91 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 366.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 505.88 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 575.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 488.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 338.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 381.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 641.87 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 505.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 660.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.12 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 697.48, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 634.0, "minimum": 27.3888, "maximum": 634.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 634.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 634.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 } ] } ] }, { "description": "Hc Analyze Neurostim,Simple/Prog", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.25, "discounted_cash": 95.0, "minimum": 29.6892, "maximum": 673.505, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 131.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 146.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 162.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 162.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 133.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 123.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 412.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 617.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 137.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 190.06, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.75, "discounted_cash": 58.0, "minimum": 3.23, "maximum": 232.995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 85.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 53.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1544.0, "discounted_cash": 306.0, "minimum": 66.7, "maximum": 1544.0, "payers_information": [ { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 429.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 297.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 444.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1544.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1544.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 423.44, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 337.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 87.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 106.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 117.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 117.74 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 291.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 429.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.87, "discounted_cash": 28.0, "minimum": 17.3, "maximum": 318.3726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.6 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.5 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.71 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.1 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 27.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 114.32 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.28 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 57.66, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.0, "discounted_cash": 37.0, "minimum": 4.65, "maximum": 316.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 52.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 57.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.64 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 52.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 36.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.64 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.8 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 74.68, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 323.0, "minimum": 194.25, "maximum": 884.17, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 339.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 339.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 420.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 314.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 323.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 469.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 420.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 388.5 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.78, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 356.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 884.17 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.95 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 333.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 485.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 404.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 343.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 339.94, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 736.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 721.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.77, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.84 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.43 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 59.66 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.43 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.16 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4234.33, "discounted_cash": 3156.0, "minimum": 127.26, "maximum": 4234.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 320.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 387.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 430.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 430.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 162.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 791.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.07 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 746.98 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 571.76 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 725.46 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 746.98 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 585.6 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.0, "discounted_cash": 8.0, "minimum": 4.84, "maximum": 308.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.14, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.93 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.73 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.22 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "discounted_cash": 114.0, "minimum": 12.0, "maximum": 722.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 157.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 328.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 389.06, "10th_percentile": 389.06, "90th_percentile": 389.06, "count": "1 through 10" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 111.0, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.51 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkal Phosphatase,Heat Stabl W/O Total", "code_information": [ { "code": "84078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.83, "discounted_cash": 8.0, "minimum": 4.96, "maximum": 143.8934, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.37 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.73 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.82 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.73 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.44 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12389.2, "discounted_cash": 3156.0, "minimum": 79.92, "maximum": 12141.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 652.4 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 499.37 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 615.47 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 471.1 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 597.74 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 615.47 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.5 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.38, "discounted_cash": 170.0, "minimum": 18.46, "maximum": 427.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.3 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 235.01, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 187.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 427.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 427.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 427.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 427.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 161.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 246.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.75, "discounted_cash": 58.0, "minimum": 3.23, "maximum": 232.995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 85.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.0, "discounted_cash": 5.0, "minimum": 3.11, "maximum": 327.32, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.15 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.57 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.97 } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8083.0, "discounted_cash": 5562.0, "minimum": 89.4, "maximum": 8083.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.4 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8083.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 476.93 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.82 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 449.93 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 570.88 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 460.82 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 8083.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.0, "discounted_cash": 8.0, "minimum": 5.26, "maximum": 168.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.76 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.97 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.06 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.82 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.42 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 34.79 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.08 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 11.0, "minimum": 6.7, "maximum": 179.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.4 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.95 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.54 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.86 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 44.23 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.7 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.48, "discounted_cash": 16.0, "minimum": 10.12, "maximum": 147.4704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.88 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.71 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.88 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.99 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1275.0, "minimum": 55.08, "maximum": 1249.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.6 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 230.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 255.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 255.29 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 4.32, "median_amount": 68.48, "10th_percentile": 68.48, "90th_percentile": 68.48, "count": "1 through 10" } ] } ] }, { "description": "Hc Ashkenazi Jewish Assoc Dsrdrs Gen Seq Anal 9 Gen", "code_information": [ { "code": "81412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2100.0, "discounted_cash": 2448.0, "minimum": 90.72, "maximum": 2100.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1469.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.0, "discounted_cash": 5.0, "minimum": 3.46, "maximum": 130.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.48 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.8, "discounted_cash": 13.0, "minimum": 7.95, "maximum": 178.164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.01 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.89 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.09 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.4 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 52.53 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.09 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.41 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12389.2, "discounted_cash": 3156.0, "minimum": 91.38, "maximum": 12141.416, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 709.7 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 572.87 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 91.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7953.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9616.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10669.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 774.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.9 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.75 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.34 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.0, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 383.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4302.0, "discounted_cash": 2062.0, "minimum": 185.8464, "maximum": 4215.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2846.28, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2268.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2726.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3294.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3651.17 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1959.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2887.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2887.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2990.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Collagen Cross Links", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.0, "discounted_cash": 18.0, "minimum": 11.21, "maximum": 278.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 71.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 71.92 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.87 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.37 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 74.06 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.78 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 37.36, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2849.22, "discounted_cash": 3156.0, "minimum": 136.08, "maximum": 2849.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.08 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2849.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2849.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2849.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2849.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 852.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 652.21 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.84 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 615.29 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2771.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 780.69 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.84 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 630.17 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1003.0, "discounted_cash": 707.0, "minimum": 43.3296, "maximum": 1003.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1003.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1003.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 976.85, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 778.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 132.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 159.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 177.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 177.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 672.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 991.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 652.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 750.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2504.13, "discounted_cash": 2062.0, "minimum": 108.1784, "maximum": 2504.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2268.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1959.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2165.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1468.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1688.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Galactose Transferase", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.1, "discounted_cash": 21.0, "minimum": 12.64, "maximum": 254.898, "payers_information": [ { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.79 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.02 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.84 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 29.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 42.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28 } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10965.0, "discounted_cash": 5562.0, "minimum": 116.7, "maximum": 10965.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.7 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7676.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6118.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10965.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10965.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10965.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10965.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5284.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 740.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 566.56 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 698.28 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.49 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4596.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 678.17 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8065.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 698.28 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 547.42 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 10965.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 14.0, "minimum": 8.87, "maximum": 246.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.98 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.97 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.36 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 58.62 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.32 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.0, "discounted_cash": 58.0, "minimum": 56.0215, "maximum": 293.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 111.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 123.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 123.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 293.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 293.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 85.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1779.0, "discounted_cash": 21.0, "minimum": 13.19, "maximum": 1743.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.35, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 76.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 84.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 84.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.15 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.83 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.76 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.71 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 87.18 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.76 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.37 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 43.98, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2624.89, "discounted_cash": 3156.0, "minimum": 106.14, "maximum": 2624.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 266.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 322.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.29 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 656.05 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 502.16 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 637.15 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 656.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 514.31 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 2624.89, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51.0, "minimum": 13.6771, "maximum": 310.268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.54 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 70.77, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 147.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 177.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 49.74, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 102.56, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.05, "discounted_cash": 279.0, "minimum": 92.7696, "maximum": 457.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 385.82, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 92.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 112.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 124.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 124.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 405.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.92, "discounted_cash": 46.0, "minimum": 27.79, "maximum": 319.4016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.58 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 63.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 132.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 160.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 178.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 178.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 57.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.4 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.39 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 189.05 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.71 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 183.61 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 67.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 189.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.21 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 92.62, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 18.0, "minimum": 10.84, "maximum": 392.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.92, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 62.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.15 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.82 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.73 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.43 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 71.6 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.73 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.8 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.12, "discounted_cash": 279.0, "minimum": 101.2536, "maximum": 519.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 385.82, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 122.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 135.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 135.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 405.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aluminum", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 973.0, "discounted_cash": 25.0, "minimum": 15.29, "maximum": 953.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.58 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.0 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.61 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 101.01 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.53 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4712.18, "discounted_cash": 3156.0, "minimum": 133.71, "maximum": 4712.18, "payers_information": [ { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.25 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 649.83 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 497.4 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1631.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 631.11 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4576.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 649.83 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.44 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3719.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3719.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3471.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3139.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3795.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4211.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4211.09 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2998.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.01, "discounted_cash": 20.0, "minimum": 1.0, "maximum": 196.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.52 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.64 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.57 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.49 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 43.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.6 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.57 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.76 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.4, "discounted_cash": 162.0, "minimum": 97.608, "maximum": 1168.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 97.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 117.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 130.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 130.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 547.0, "discounted_cash": 15.0, "minimum": 9.05, "maximum": 536.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.96 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.58 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.13 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 59.8 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 929.0, "minimum": 125.4874, "maximum": 2846.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1394.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1282.86, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1022.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1283.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1550.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1718.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1718.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 883.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 957.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1394.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1533.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1162.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 985.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1440.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1533.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 901.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 892.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 1026.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1347.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 1859.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.24, "discounted_cash": 3.0, "minimum": 2.36, "maximum": 270.7152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.58 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.4, "discounted_cash": 162.0, "minimum": 70.9296, "maximum": 1168.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 85.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 95.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 95.0 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "minimum": 1.0, "maximum": 619.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.41 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.62 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.41 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 } ] } ] }, { "description": "Hc Antibody Hla Class Ii Phenotype Panel Qual", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 81.0, "minimum": 49.13, "maximum": 592.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 112.99, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 235.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 284.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 315.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 315.24 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 102.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 354.33 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.21 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 334.27 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 255.86 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 79.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 324.64 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 334.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.05 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 163.76, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 16.0, "minimum": 10.0, "maximum": 362.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.2 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.04 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.08 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 66.08 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.34 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.4, "discounted_cash": 162.0, "minimum": 113.5344, "maximum": 1168.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 113.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 137.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 152.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 152.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 227.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.0, "minimum": 1.0, "maximum": 391.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.87 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.36 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 60.09 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.87 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.5 } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 13.0, "minimum": 7.94, "maximum": 276.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.29 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.04 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.37 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 52.49 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.37 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 601.0, "minimum": 1.0, "maximum": 588.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.97 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.8 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.82 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.69 } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.17, "discounted_cash": 279.0, "minimum": 104.2776, "maximum": 654.8066, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 385.82, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 104.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 126.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 139.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 405.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.4, "discounted_cash": 25.0, "minimum": 15.33, "maximum": 268.912, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 98.37 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.3 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.83 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 101.29 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.76 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.66 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.26, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.46 } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.21, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 51.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.91 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.77 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.56 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 727.0, "discounted_cash": 38.0, "minimum": 23.17, "maximum": 712.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.3, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 110.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 134.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 148.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 148.69 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.92 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.66 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.12 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.66 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.6 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1397.1, "discounted_cash": 358.0, "minimum": 2.3, "maximum": 1369.158, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 394.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 813.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 983.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1091.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1091.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 447.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 347.56, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 519.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.0, "discounted_cash": 21.0, "minimum": 12.65, "maximum": 409.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.29 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.87 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.12 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.92 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 83.64 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.51 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 7.0, "minimum": 4.38, "maximum": 246.96, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 28.93 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.36 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.11 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.17 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.8 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.3 } ] } ] }, { "description": "Hc Assay Of Alcohol (Ethanol) Breath", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.3, "discounted_cash": 30.0, "minimum": 1.0, "maximum": 161.994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.4, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 104.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 115.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 115.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.37 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.74 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 118.94 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 43.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin, Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.0, "discounted_cash": 8.0, "minimum": 4.84, "maximum": 152.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.18 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 31.95 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.79 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.0, "discounted_cash": 18.0, "minimum": 11.38, "maximum": 513.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 73.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.82 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.42 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.26 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 75.19 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.42 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.69 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 980.0, "discounted_cash": 11.0, "minimum": 7.11, "maximum": 960.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.62 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.26 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.23 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.01 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 46.96 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.91 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 867.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 849.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.9 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 156.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 156.89 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.98 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.36 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.34 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 161.57 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.42 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 12.0, "minimum": 7.27, "maximum": 182.28, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.39 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.83 }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "minimum": 1.0, "maximum": 372.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.12 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.52 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "UHC Medicaid", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 43.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.9 } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592.13, "discounted_cash": 279.0, "minimum": 132.1824, "maximum": 592.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 592.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 592.13 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 385.82, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 132.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 159.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO/POS (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 177.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 177.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care N Care Insurance Company", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks FKA (ROCKPORT COMMUNITY NETWORK) WorkerComp", "plan_name": "Careworks Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Workers Comp", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Elap Services", "plan_name": "Elap Services Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Employee Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies MCR", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage MMP", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare -Prison", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 293.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Commercial Exchange EPO HMO", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan/Wellcare", "plan_name": "Superior Health Plan Medicare Advantage/MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TOTAL PLANS SRVICES", "plan_name": "TOTAL PLANS SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 391.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Options PPO", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA SENIOR CARE NETWORK", "plan_name": "USA SENIOR CARE NETWORK", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellPath", "plan_name": "WellPath Medicare Prison", "methodology": "fee schedule", "standard_charge_dollar": 405.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation Consolidated", "methodology": "fee schedule", "standard_charge_dollar": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "discounted_cash": 114.0, "minimum": 12.0, "maximum": 722.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 157.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Blue Advantage (07-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 328.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO/Blue Essentials (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 397.07 }, { "payer_nam