{ "hospital_name": "Dallas Medical Center", "last_updated_on": "2026-09-01", "version": "3.0", "location_name": [ "Dallas Medical Center" ], "hospital_address": [ "7 Medical Parkway Dallas, TX 75234" ], "license_information": { "license_number": "100214", "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": [ "1861690364", "1356538839" ], "standard_charge_information": [ { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14685.93, "minimum": 951.6483, "maximum": 14685.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1376.15 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1361.97 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1418.71 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9245, "minimum": 3310, "maximum": 15255.108, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14792.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13868.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10170.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8196.27 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8783.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "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": 9522.89, "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": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12296.54, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12019.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11556.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10212.5 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8320.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9800.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14330.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9707.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9707.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12019.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15255.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7495.46 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "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": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9245.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13221.09, "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": 8088, "minimum": 3310, "maximum": 13345.992, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12941.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12132.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8897.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9601.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7684.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "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": 8331.13, "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": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10757.68, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10515.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10110.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8568.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7279.63, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8573.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12537.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8492.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12537.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8492.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10515.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13345.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4027.84 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "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": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8331.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8088.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11566.53, "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": 8722, "minimum": 3310, "maximum": 16100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13955.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13083.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9594.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9446.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8286.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "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": 8983.87, "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": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11600.53, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10902.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9468.99 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7849.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9245.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13519.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9158.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13519.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9158.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14391.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9542.31 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "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": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12472.75, "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": 14293, "minimum": 3310, "maximum": 23584.737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22870.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21440.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15723.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15159.56 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13579.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "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": 14722.61, "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": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19010.73, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18581.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17867.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17384.78 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12864.4, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15151.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22155.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15008.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22155.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15008.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18581.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23584.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6762.25 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "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": 14293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14722.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20440.11, "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": 21457, "minimum": 3310, "maximum": 35404.9575, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21457.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26255.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 21457.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "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": 21457.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22101.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30684.3, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 34332.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32186.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23603.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 24742.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20384.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "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": 22101.23, "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": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28538.54, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27894.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26821.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27562.65 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19311.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22744.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33259.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 22530.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33259.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22530.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 27894.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 35404.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21457.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8940, "minimum": 1019, "maximum": 14752.4025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14305.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13411.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9834.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8493.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "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": 9209.08, "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": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11891.33, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11623.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11176.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9779.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8046.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9477.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13858.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9387.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13858.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9387.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11623.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14752.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5768.24 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "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": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9209.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12785.42, "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": 7690, "minimum": 2718.6, "maximum": 12689.5065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12304.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11535.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8459.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5941.63 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7306.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "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": 7921.33, "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": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10228.51, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9997.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9613.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8003.37 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6921.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8152.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11920.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8075.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11920.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8075.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9997.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12689.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2718.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "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": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7921.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7690.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10997.57, "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": 8646, "minimum": 3310, "maximum": 14266.2465, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13833.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12969.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9510.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8602.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8213.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "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": 8905.6, "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": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11499.46, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11240.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10807.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9361.03 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7781.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9164.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13401.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9078.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13401.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9078.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11240.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14266.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9018.09 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "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": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8905.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8646.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12364.08, "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": 17010, "minimum": 3310, "maximum": 28066.566, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17010.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17720.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17010.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "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": 17010.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17520.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24324.36, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27216.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25515, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18711.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19507.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16159.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "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": 17520.3, "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": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22623.35, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21262.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21243.87 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15309.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26365.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17860.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26365.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17860.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28066.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17010, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10799, "minimum": 3310, "maximum": 17819.538, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17279.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16199.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11879.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10794.24 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10259.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "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": 11123.69, "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": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14363.63, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14039.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13499.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12420.61 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9719.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11447.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16739.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11339.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11339.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14039.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17819.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10799.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12385.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10799.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "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": 10799.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11123.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10799.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15443.6, "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": 41413, "minimum": 3310, "maximum": 79965.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 66261.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62119.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 45554.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 55836.37 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39342.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "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": 42655.7, "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": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 55079.7, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53837.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51766.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 55914.63 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 37271.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43898.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64190.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 43483.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64190.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43483.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 53837.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 68331.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41413.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79965.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41413.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "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": 41413.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 42655.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 41413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59221.03, "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": 13556, "minimum": 3310, "maximum": 22368.7695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21690.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20335.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14912.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15008.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12878.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "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": 13963.5, "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": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18030.58, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17623.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16946, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16337.76 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12201.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14370.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21013.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14234.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21013.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14234.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17623.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22368.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13377 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13556.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "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": 13556.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13963.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13556.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19386.27, "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": 7241, "minimum": 3310, "maximum": 11947.8645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11585.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10861.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7965.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6695.64 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6879.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "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": 7458.36, "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": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9630.7, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9413.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9051.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7364.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6517.02, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7675.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11223.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7603.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11223.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7603.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9413.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11947.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8089.06 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "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": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7458.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7241.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10354.82, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10396, "minimum": 3310, "maximum": 18860, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16634.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15595.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11436.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10970.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9876.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "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": 10708.7, "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": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13827.78, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13515.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12996, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11848.21 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9357.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11020.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16115.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10916.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16115.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10916.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13515.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17154.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10396.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4239.47 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10396.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "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": 10396.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10708.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10396.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14867.47, "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": 6350, "minimum": 3310, "maximum": 10478.7705, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10161.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9526.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 6985.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4581.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6033.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "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": 6541.29, "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": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8446.52, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8256, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7938.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6099.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5715.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6731.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9843.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6668.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9843.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6668.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8256, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10478.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5472.32 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "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": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6541.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6350.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9081.6, "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": 12088, "minimum": 3310, "maximum": 19946.289, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19341.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18133.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13297.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14527.37 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11484.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "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": 12451.36, "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": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16077.92, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15715.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15110.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14251.87 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10879.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12814.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18737.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12693.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18737.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12693.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15715.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19946.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12088.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14477.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12088.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "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": 12088.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12451.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12088.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17286.78, "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": 7019, "minimum": 3310, "maximum": 11582.3565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11231.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10529.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7721.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6775.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6668.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "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": 7230.2, "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": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9336.08, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9125.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8774.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7050.06 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6317.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7440.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10880.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7370.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10880.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7370.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9125.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11582.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7222.37 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "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": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7230.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7019.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10038.04, "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": 16257, "minimum": 3310, "maximum": 26824.5615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26011.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24385.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17883.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17208.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15444.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "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": 16745.02, "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": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21622.22, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21134.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20321.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20174.45 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14631.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17232.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25198.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17070.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25198.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17070.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21134.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26824.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16257.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24830 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16257.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "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": 16257.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16745.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16257.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23247.95, "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": 10586, "minimum": 3310, "maximum": 21661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16937.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10217.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10056.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "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": 10903.68, "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": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14079.5, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13761.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13232.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12117.09 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9527.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11221.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16408.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11115.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16408.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11115.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13761.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17467.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10586.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21661 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10586.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "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": 10586.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10903.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10586.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15138.11, "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": 15426, "minimum": 3310, "maximum": 25453.6425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24682.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23139.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16969.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17238.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14655.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "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": 15889.3, "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": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20517.18, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20054.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19283.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18994.01 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13883.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16352.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23911, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16197.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23911.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16197.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20054.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25453.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15426.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18093.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15426.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "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": 15426.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15889.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15426.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22059.82, "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": 17769, "minimum": 3310, "maximum": 29320.3845, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17769.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23872.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17769.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "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": 17769.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25411, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28431.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26654.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19546.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 22027.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16881.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "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": 18303, "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": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23634.01, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23100.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22212.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22323.48 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15992.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18836.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27543.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18658.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27543.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18658.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 23100.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 29320.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17769.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27995, "minimum": 3310, "maximum": 46192.5585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44792.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41993.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30795.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 31034.36 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26595.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "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": 28835.37, "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": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37234, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36394.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34994.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 36851.37 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25195.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29675.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43393.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 29395.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43393.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 29395.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 36394.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 46192.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27995.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34769.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27995.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "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": 27995.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28835.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 27995.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40033.55, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34764, "minimum": 3310, "maximum": 57361.029, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 55622.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 52146.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 38240.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 49965.81 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33026.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "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": 35807.23, "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": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46236.47, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45193.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43455.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 46468.04 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 31287.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36850.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53884.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36502.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53884.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36502.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 45193.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 57361.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34764.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47630.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 34764.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "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": 34764.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 35807.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 34764.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49712.89, "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": 12205, "minimum": 1019, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19528.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18308.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13426.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11595.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "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": 12571.67, "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": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16233.33, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15867.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15256.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14417.89 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10984.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12937.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18918.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12815.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18918.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12815.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15867.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20139.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12205.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6462.82 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12205.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "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": 12205.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12571.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12205.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17453.88, "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": 6557, "minimum": 3310, "maximum": 17293.3, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17293.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "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": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6753.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9376.84, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10491.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9835.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7212.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6819.31 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6229.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "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": 6753.95, "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": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8721.12, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8524.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8196.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6393.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5901.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6950.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10163.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6885.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10163.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6885.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8524.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10819.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6557.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10130, "minimum": 3310, "maximum": 17020, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16208.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15195.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11143.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9934.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9623.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "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": 10434.11, "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": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13473.1, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13169.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12662.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11469.33 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9117.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10738.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15701.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10636.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15701.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10636.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13169.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16714.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10130.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13695.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10130.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "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": 10130.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10434.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10130.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14486.11, "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": 14112, "minimum": 3310, "maximum": 23285.4765, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22579.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15523.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15667.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13406.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "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": 14535.77, "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": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18769.51, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18346.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17640.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17127.1 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12701.17, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14959.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21874.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14818.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21874.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14818.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18346.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23285.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14112.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13521 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14112.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "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": 14112.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14535.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14112.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20180.75, "additional_payer_notes": "143.00% 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": 14567, "minimum": 1019, "maximum": 24036.5895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23308.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21851.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16024.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13839.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "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": 15004.63, "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": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19374.95, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18937.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18209.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17773.84 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13110.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15441.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22579.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15295.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22579.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15296.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18937.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 24036.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14567.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10294 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14567.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "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": 14567.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15004.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14567.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20831.71, "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": 7820, "minimum": 3310, "maximum": 12903.6105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12512.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11730.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8602.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7301.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7429.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "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": 8054.98, "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": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10401.09, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10166.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9775.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8187.72 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7038.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8289.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12121.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8211.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12121.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8211.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10166.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12903.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8773.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "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": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8054.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7820.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11183.13, "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": 8385, "minimum": 1019, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13417.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12578.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9224.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7966.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "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": 8637.56, "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": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11153.35, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10901.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10482.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8991.32 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7547.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8889.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12998.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8805.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12998.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8805.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10901.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13836.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "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": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8637.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8385.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11991.95, "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": 6833, "minimum": 3310, "maximum": 11276.001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10934.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10250.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7517.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6066.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6492.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "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": 7038.96, "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": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9089.14, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8884.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8542.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6786.27 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6150.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7243.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10592.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7175.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7175.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8884.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11276, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3878.57 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "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": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7038.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6833.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9772.53, "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": 6479, "minimum": 1019, "maximum": 10691.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10367.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9719.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7127.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6155.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "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": 6674.19, "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": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8618.13, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8423.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8099.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6283.13 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5831.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6868.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10043.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6803.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10043.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6803.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8423.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10691.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3387.71 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "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": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6674.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9266.11, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 88211, "minimum": 3310, "maximum": 145548.414, "payers_information": [ { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 88211.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "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": 88211.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 90857.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 126141.96, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 141137.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 132316.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 97032.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83800.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "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": 90857.54, "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": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 117320.84, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 114674.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 110264, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 79390.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 93503.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 136727.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 92621.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 136727.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 92621.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 114674.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 145548.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 88211.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103135 } ] } ] }, { "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": 11981, "minimum": 3310, "maximum": 20240, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19170.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17972.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13180.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14687.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11382.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "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": 12341.36, "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": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15935.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15576.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14977.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14100.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10783.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12700.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18571.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12581, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18571.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12580.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15576.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19770.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14717 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "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": 11981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12341.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11981.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17134.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Finger/Thumb - 26952 - OR36026952", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23623.2, "discounted_cash": 3270, "minimum": 959.1178, "maximum": 18898.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2579.63 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2553.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2659.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% 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": 18371, "minimum": 3310, "maximum": 30312.7935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29394.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27557.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20208.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20244.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17452.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "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": 18922.54, "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": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24433.95, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23882.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22964.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23178 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16534.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19473.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28475.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19289.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28475.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19289.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 23882.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 30312.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18371.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18360.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 18371.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "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": 18371.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18922.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 18371.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26271.09, "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": 32832, "minimum": 3310, "maximum": 54173.2455, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29549.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34802.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50890.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 34473.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50890.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 34473.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 42681.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 54173.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32832.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50652.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 32832.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "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": 32832.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 33817.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46950.15, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 52531.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49248.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 36115.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 37587.87 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31190.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "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": 33817.27, "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": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43666.92, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42681.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41040.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 43723.19 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32832.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37340, "minimum": 3310, "maximum": 61611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 59744, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56010, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 41074, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 44379.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35473, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "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": 38460.2, "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": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49662.2, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48542, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46675, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 50127.51 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33606, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39580.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57877, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 39207, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57877, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 39207, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 48542, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 61611, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34749.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "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": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 38460.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 37340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53396.2, "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": 10517, "minimum": 3310, "maximum": 17354.667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16828.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15777, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11569.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10703.79 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9992.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "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": 10833.54, "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": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13988.91, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13673.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13147.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12020.34 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9466.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16302.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11043.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16302.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11043.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13673.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17354.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10517.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7555.18 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10517.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "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": 10517.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10833.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10518, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15040.71, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Thru Metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 3270, "minimum": 1629.9792, "maximum": 25154, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2576.4 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2549.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2656.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22332.5, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 17866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1710.11 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1692.48 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1763 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% 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": 15465, "minimum": 3310, "maximum": 26220, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24744.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23197.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17011.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18772.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14691.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "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": 15929.16, "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": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20568.66, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20104.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19331.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19049.01 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13918.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16393.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23971, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16238.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23971.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16238.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20104.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25517.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15465.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13348 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15465.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "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": 15465.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15929.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22115.18, "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": 22492, "minimum": 3310, "maximum": 37111.8165, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 35987.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33738, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24741.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 25748.91 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21367.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "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": 23166.76, "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": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29914.37, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29239.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28115, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 29032.34 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 20242.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23841.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34862.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 23616.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34862.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23616.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 29239.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 37111.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22492.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18299.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 22492.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "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": 22492.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23166.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 22492, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32163.57, "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": 12224, "minimum": 3310, "maximum": 20171.0355, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17481.56, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19559.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18337.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13447.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12025.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11613.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "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": 12591.65, "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": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16259.08, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15892.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15281.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14445.39 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11002.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12958.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18948.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12836.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18948.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12836.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15892.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20171.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12224.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12136.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12224.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "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": 12224.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Finger/Thumb - 26951 - OR36026951", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 3270, "minimum": 959.1178, "maximum": 16551.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2645.76 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2618.48 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2727.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11439, "minimum": 3310, "maximum": 18875.8185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18303.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17159.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12583.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12389.01 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10867.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "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": 11783.1, "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": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15215.05, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14871.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14299.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13330.13 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10295.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12126.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17731.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12011.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17731.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12011.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14871.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18875.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11439.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11799.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11439.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "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": 11439.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16359.04, "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": 27057, "minimum": 3310, "maximum": 46000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 43292.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40586.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29763.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 36812.64 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25704.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "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": 27869.53, "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": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35986.89, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35175.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33822.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 35519.17 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24352.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28681.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41939.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28410.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41939.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28410.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 35175.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 44645.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27057.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21560 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27057.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "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": 27057.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 27057.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38692.67, "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": 32332, "minimum": 3310, "maximum": 53348.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 51732.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48498.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 35565.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 39819.44 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30715.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "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": 33302.58, "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": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43002.36, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42032.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40415.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 43013.29 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29099.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34272.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50115.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 33949.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50115.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33949.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 42032.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 53348.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6022.89 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "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": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 33302.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 32332.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46235.62, "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": 18514, "minimum": 3310, "maximum": 30548.1825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29622.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27771, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20365.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 22718.11 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17588.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "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": 19069.42, "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": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24623.69, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24068.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23142.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23380.69 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16662.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19624.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28696.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19439.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28696.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19439.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 24068.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 30548.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18514.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23068.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 18514.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "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": 18514.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19069.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 18514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26475.09, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7315.02, "discounted_cash": 3270, "minimum": 474.01, "maximum": 7315.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7315.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7315.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7315.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7315.02 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 645.97 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 639.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 665.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7089, "minimum": 3310, "maximum": 11697.0975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11342.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10633.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7798.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6432.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6734.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "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": 7301.82, "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": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9428.57, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9215.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8861.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7148.85 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6380.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7514.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10988.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7443.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10988.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7443.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9215.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5797.22 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "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": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7301.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7089.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10137.48, "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": 8298, "minimum": 3310, "maximum": 13692.5745, "payers_information": [ { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10373.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8867.06 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7468.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8796.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12862.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8713.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12862.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8713.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10788.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13692.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6480.38 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "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": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8547.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11866.9, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13277.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12447.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9128.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9037.96 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7883.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8298.53, "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": 8547.49, "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": 8298.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11037.04, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10788.09, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Wrist With Autograft", "code_information": [ { "code": "25825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133995, "discounted_cash": 7253, "minimum": 1900, "maximum": 107196, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7978.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21355.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16031.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.24 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2915.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3037.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% 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": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.03 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 12641.69 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 16964.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.03 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6883, "minimum": 3310, "maximum": 11357.6265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11013.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10325.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7571.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6242.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6539.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "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": 7089.91, "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": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9154.94, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8948.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8604.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6856.54 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6195.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7296.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10669.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7227.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10669.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7227.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8948.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11357.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4574.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "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": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7089.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6883.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9843.28, "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": 51363, "minimum": 3310, "maximum": 84749.9235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 82181.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 77045.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 56499.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 64184 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48795.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "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": 52904.51, "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": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 68313.57, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66772.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64204.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 70051.41 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 46227.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54445.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 79613.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 53931.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 79613.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 53931.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 66772.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 84749.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51363.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13249.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 51363.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "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": 51363.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 52904.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 51363.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73449.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19225, "minimum": 3310, "maximum": 31722.7515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 30761.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28838.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21148.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18264.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "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": 19802.68, "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": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25570.46, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24993.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24032.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24392.06 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17303.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29800.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20187.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29800.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20187.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 24993.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 31722.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19225.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25539.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19225.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "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": 19225.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19802.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19225.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27493.05, "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": 28849, "minimum": 3310, "maximum": 47601.3285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 46158.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43273.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 31734.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 33079.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27406.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "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": 29714.78, "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": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38369.56, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37504.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36061.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 38064.4 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25964.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30580.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44716.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 30291.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44716.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30291.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 37504.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 47601.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28849.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28936 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 28849.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "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": 28849.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29714.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 28849.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41254.48, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Pst Tq 1Ntrspc Lumbar", "code_information": [ { "code": "22612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47766.8, "discounted_cash": 17527, "minimum": 1900, "maximum": 47245.8187, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24187.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19280.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42485.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 31893.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 47245.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 47245.82 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16651.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 18053.22, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 5649.33 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17001.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 26291.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24538.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18579.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 5591.09 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "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": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 5824.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 22785.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 7051.26 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18053.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 26865.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 36051.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7051.26 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35054.8, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12908, "minimum": 3310, "maximum": 22965, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22965 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12908.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "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": 12908.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13295.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18458.53, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20652.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19362.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14198.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12262.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "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": 13295.34, "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": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17167.72, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16780.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16135.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15416.02 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11617.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13682.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20007.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13553.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20007.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13553.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16780.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21298.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12908.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12908.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Si Jt Perq/Min Nvas", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61177.2, "discounted_cash": 17527, "minimum": 1900, "maximum": 82566.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24187.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19280.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 56927.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 42735.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 61177.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 61177.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16651.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 18053.22, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2949.8 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17001.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 26291.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24538.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18579.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2919.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "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": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3041.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 22785.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6864 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18053.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35054.8, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10263, "minimum": 3310, "maximum": 16934.7585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15395.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11289.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9750.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "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": 10571.41, "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": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13650.44, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12829.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11658.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9237.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10879.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15908.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10776.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15908.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10776.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16934.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14771.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "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": 10263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10263.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14676.79, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Banana Bag Without Folic Acid (Site)", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "09999401340", "type": "NDC" }, { "code": "J7030", "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, "median_amount": 15, "10th_percentile": 15, "90th_percentile": 30, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20547, "minimum": 3310, "maximum": 33902.748, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32875.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30820.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22601.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23146.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19519.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "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": 21163.51, "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": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27327.67, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26711.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25683.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26269.15 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18492.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21779.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31848.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21574.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31848.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21574.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 26711.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 33902.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22366.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "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": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21163.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29382.38, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12307.4514, "maximum": 18400, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15447.5 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17122.1 } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41384.8, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 33107.84, "payers_information": [ { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 3035.59 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3162.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 3067.22 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% 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": 19686, "minimum": 3310, "maximum": 32483.319, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31498.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29530.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21655.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 21751.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18702.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "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": 20277.51, "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": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26183.52, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25592.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24608.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25046.95 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17718.17, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20868.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30514.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20671.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30514.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20671.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 25592.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 32483.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19686.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17502.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19686.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "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": 19686.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20277.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28152.21, "additional_payer_notes": "143.00% 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": 41650, "minimum": 3310, "maximum": 68723.4735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 66640.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62475.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 45815.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 56077.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39568.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "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": 42900.12, "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": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 55395.28, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 54145.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52063.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 56251.76 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 37485.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44149.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64558.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 43733.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64558.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43733.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 54145.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 68723.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41650.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59813.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41650.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "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": 41650.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 42900.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 41650.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59560.34, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10635, "minimum": 3310, "maximum": 17548.6575, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17016.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15953.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11699.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10091.91 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10103.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "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": 10954.57, "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": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14145.28, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13826.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13294.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12187.37 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9572, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11273.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11167.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11167.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13826.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17548.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10635.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11338.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10635.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "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": 10635.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10954.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15208.84, "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": 21126, "minimum": 3310, "maximum": 34858.4775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33802.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31689.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 23238.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 29017.82 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20070.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "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": 21760.09, "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": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28098.05, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27464.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26407.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27092.1 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19013.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22393.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32745.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 22182.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32745.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22182.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 27464.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 34858.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21126.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20866.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 21126.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "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": 21126.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21760.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 21126.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30210.68, "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": 13439, "minimum": 3310, "maximum": 22174.779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21502.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20158.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14783.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14449.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12767.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "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": 13842.48, "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": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17874.22, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17471.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16799.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16170.72 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12095.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14245.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20830.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14111.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20830.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14111.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17471.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22174.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13439.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18202.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13439.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "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": 13439.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13842.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13439.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.14, "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": 44566, "minimum": 3310, "maximum": 74980, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 71305.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 66849.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 49022.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42337.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "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": 45903.08, "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": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59272.97, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57935.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55707.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40109.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47240.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69077.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 46794.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69077.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 46794.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 57935.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 73534.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44566.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44106.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 44566.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "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": 44566.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 45903.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 44566.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63729.58, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11350, "minimum": 3310, "maximum": 18860, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18160.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12485.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11705.14 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10782.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "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": 11690.81, "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": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15095.87, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14755.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14187.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13202.82 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10215.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12031.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17592.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11917.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17592.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11917.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14755.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18727.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11350.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12729.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11350.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "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": 11350.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11690.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11350.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16230.9, "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": 41000, "minimum": 3310, "maximum": 74980, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 65600.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 61500.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 45100.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38950.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "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": 42230.41, "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": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54530.52, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53300.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51250.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 36900.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43460.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 63550.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 43050.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63550.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43050.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 53300.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 67650.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41000.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58830.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41000.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "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": 41000.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 42230.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 41000.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58630.56, "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": 12766, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20426.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19150.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14043.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13081.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12128.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "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": 13149.8, "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": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16979.88, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16596.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15958.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15215.37 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11490.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13532.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19788.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13405.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19788.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13405.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16596.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21065.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12766.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15330.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12766.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "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": 12766.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13149.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12766.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18256.57, "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": 9019, "minimum": 3310, "maximum": 14882.5215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14431.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13529.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9921.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8911.52 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8568.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "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": 9290.3, "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": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11996.21, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11725.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11274.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9891.67 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8117.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9560.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13980.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9470.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13980.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9470.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11725.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14882.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6423.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "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": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9290.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9019.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12898.19, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6860, "minimum": 3310, "maximum": 11319.7755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10976.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10290.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7546.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6511.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6517.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "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": 7066.28, "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": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9124.43, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8918.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8575.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6823.95 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6174.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7272.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10633.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7203.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10633.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7203.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8918.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11319.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4151.66 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "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": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7066.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6860.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9810.47, "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": 10446, "minimum": 3310, "maximum": 17940, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11830.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9923.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "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": 10759.69, "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": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13893.57, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13580.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13057.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11918.49 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9401.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11073.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16191.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10968.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16191.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10968.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13580.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17236.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10446.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12306.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10446.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "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": 10446.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10759.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14938.19, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16714.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15669.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11490.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10446.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17665, "minimum": 3310, "maximum": 29148.867, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28265.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26499, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19432.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19512.87 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16782.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "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": 18195.98, "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": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23495.75, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22965.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22082.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22175.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15899.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18725.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27382.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18549.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27382.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18549.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22965.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 29148.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17665.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23790.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17665.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "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": 17665.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18195.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25262.35, "additional_payer_notes": "143.00% 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": 16396, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26234.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24594.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18036.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18067.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15576.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "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": 16888.29, "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": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21807.2, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21315.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20495.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20372.04 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14756.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17380.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25414.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17216.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25414.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17216.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21315.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 27054.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16396.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19568.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16396.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "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": 16396.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16888.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23446.84, "additional_payer_notes": "143.00% 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": 27618, "minimum": 3310, "maximum": 51214.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44189.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41427.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30380.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 34604.14 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26237.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "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": 28446.95, "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": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36732.49, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35903.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34523, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 36315.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24856.57, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29275.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42808.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28999.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42808.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28999.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 35903.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 45570.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27618.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51214.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27618.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "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": 27618.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28446.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 27618.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39494.33, "additional_payer_notes": "143.00% 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": 27287, "minimum": 3310, "maximum": 45023.8965, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 33529.88 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25922.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "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": 28105.82, "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": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36291.99, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35473.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34109, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 35845.09 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24558.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28924.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42295.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28651.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42295.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28651.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 35473.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 45023.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27287.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28975.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27287.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "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": 27287.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28105.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39020.71, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 43659.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40930.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30015.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 27287.2, "additional_payer_notes": "100.00% 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": 26822, "minimum": 3310, "maximum": 44257.4055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 42916.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40234.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 29504.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 30980.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25481.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "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": 27627.38, "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": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35674.15, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34869.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33528.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 35185.1 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24140.4, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28432.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41575.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28163.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41575.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28163.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 34869.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 44257.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26822.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39224.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 26822.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "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": 26822.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 27627.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 26822.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38356.42, "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": 20547, "minimum": 3310, "maximum": 33902.748, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32875.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30820.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22601.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 21517.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19519.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "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": 21163.51, "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": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27327.67, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26711.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25683.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26269.15 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18492.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21779.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31848.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21574.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31848.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21574.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 26711.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 33902.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17102.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "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": 20547.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21163.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 20547.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29382.38, "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": 15383, "minimum": 3310, "maximum": 25382.676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24613.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23075.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16921.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16698.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14614.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "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": 15844.9, "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": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20459.98, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19998.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19229.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18932.9 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13845.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16306.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23844.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16152.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23844.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16152.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 19998.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25382.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14706.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15383.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "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": 15383.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15844.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15383.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21998.32, "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": 16934, "minimum": 1019, "maximum": 27942.354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27095.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25402.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18628.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16088.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "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": 17442.84, "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": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22523.23, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22015.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21168.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21136.93 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15241.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17950.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26248.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17781.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26248.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17781.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22015.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 27942.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16934.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10780.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16934.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "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": 16934.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17442.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16934.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24216.71, "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": 5319, "minimum": 3310, "maximum": 8777.8185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 8511.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7979.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 5851.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4505.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5053.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "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": 5479.49, "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": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7075.45, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6915.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6649.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 4635.19 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 4787.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5639.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8245.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 5585.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8245.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 5585.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 6915.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 8777.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4305.33 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "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": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 5479.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 5319.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7607.44, "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": 7233, "minimum": 3310, "maximum": 11934.846, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11573.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7956.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6859.92 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6871.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "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": 7450.24, "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": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9620.21, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9403.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9041.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7353.57 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6509.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7667.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11211.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7594.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11211.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7594.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9403.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11934.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3421.08 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "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": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7450.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7233.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10343.53, "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": 7331, "minimum": 3310, "maximum": 12096.909, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11730.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8064.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6916.21 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6964.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "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": 7551.4, "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": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9750.84, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9530.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9164.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7493.1 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6598.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11363.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7698.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11363.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7698.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9530.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12096.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4661.83 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "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": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10483.99, "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": 10688, "minimum": 3310, "maximum": 17636.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11068.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10154.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "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": 11009.26, "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": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14215.84, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13895.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13360.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12262.74 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9619.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11329.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16567.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16567.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13895.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17636.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8421.86 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "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": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11009.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15284.7, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17101.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16032.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11757.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10688.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45117, "minimum": 3310, "maximum": 74443.743, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 72187.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 67676.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 49629.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42861.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "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": 46470.92, "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": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 60006.17, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58652.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56396.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 61177.22 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40605.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47824.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69932, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 47373.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69931.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 47373.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 58652.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 74443.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45117.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33082.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 45117.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "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": 45117.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 46470.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 45117.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64517.91, "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": 17403, "minimum": 3310, "maximum": 28715.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27845.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26105.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19143.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16836.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16533.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "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": 17925.71, "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": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23146.79, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22624.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21754.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21803.03 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15663.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18447.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26975.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18273.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26975.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18273.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22624.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28715.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28079.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "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": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17925.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17403.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24887.15, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8008, "minimum": 3310, "maximum": 13213.5135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12813.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12012.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8809.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7294.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7607.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "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": 8248.44, "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": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10650.89, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10410.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10010.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8454.57 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7207.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8488.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12412.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8408.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12412.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8408.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10410.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13213.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4883.99 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "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": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8248.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8008.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11451.71, "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": 40287, "minimum": 3310, "maximum": 66473.6985, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 49835.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38272.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "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": 41495.71, "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": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53581.83, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52373.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50358.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 54314.57 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 36258.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42704.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62444.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 42301.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62445.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 42301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 52373.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 66473.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46025.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 40287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "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": 40287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 41495.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57610.54, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 64459.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60430.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 44315.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 40287.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24582, "minimum": 3310, "maximum": 40561.0095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 39331.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36873.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27040.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 29544.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23353.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "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": 25319.87, "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": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32694.63, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31957.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30728, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32002.29 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22124.19, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26057.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38102.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25811.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38102.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25811.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 31957.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 40561.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24582.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27344.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 24582.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "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": 24582.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25319.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 24582.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35152.87, "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": 15886, "minimum": 3310, "maximum": 26560.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25418.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23830.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17475.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16027.08 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15092.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "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": 16363.3, "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": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21129.3, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20652.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19858.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19647.88 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14298.02, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16839.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24624.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16681.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24624.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16681.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20652.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26213.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15886.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26560.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15886.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "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": 15886.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16363.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15886.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22717.97, "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": 25376, "minimum": 3310, "maximum": 51880.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40601.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38064, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27913.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 33078.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24107.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "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": 26137.28, "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": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33750.09, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32988.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31720, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 33129.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22838.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26898.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39332.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 26644.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39332.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26644.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 32988.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 41870.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25376.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51880.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 25376.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "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": 25376.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26137.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 25376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36287.69, "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": 29805, "minimum": 3310, "maximum": 49179.2565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 47688.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44708.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32786.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 36681.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28315.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "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": 30699.77, "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": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39641.46, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38747.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37257, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39423.08 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 26825.05, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31593.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46198.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 31295.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46198.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31295.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 38747.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 49179.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29805.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37903.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 29805.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "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": 29805.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 30699.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 29805.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42622.02, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22156.1, "discounted_cash": 1952, "minimum": 659.94, "maximum": 17724.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3220.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6138.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4607.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6825.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6825.82 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1621.1 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1893.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2440.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2069.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1604.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3025.62, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1671.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3220.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% 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": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 659.94 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2010.57, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2514.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3374.09 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 659.94 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3904.02, "additional_payer_notes": "200.00% 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": 49194, "minimum": 3310, "maximum": 81170.6115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 78710.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 73791.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 54113.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 59922.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46734.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "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": 50670.13, "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": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 65428.43, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63952.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 61492.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 66969.43 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 44274.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52145.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 76251.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 51654.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76251.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 51654.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 63952.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 81170.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46118.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "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": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 50670.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70347.86, "additional_payer_notes": "143.00% 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": 72188, "minimum": 3310, "maximum": 119110.53, "payers_information": [ { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "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": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 74353.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 103229.13, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 115501.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 108282.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 79407.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 96259.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68578.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "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": 74353.85, "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": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 96010.31, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 93844.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 90235.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 99637.82 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 64969.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 76519.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 111891.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 75797.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 111891.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 75797.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 93844.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 119110.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 72188.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100783 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6602, "minimum": 3310, "maximum": 10893.9435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10563.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7262.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6502.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6272.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "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": 6800.46, "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": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8781.18, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8583.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8252.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6457.29 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5942.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6998.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10233.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6932.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10233.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6932.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8583.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10893.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6865.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "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": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6800.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6602.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9441.42, "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": 15984, "minimum": 3310, "maximum": 26375.085, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25575.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23977.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17583.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17084.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15185.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "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": 16464.45, "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": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21259.92, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20780.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19981.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19787.42 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14386.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16943.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24776.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16784.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24776.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16784.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20780.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26375.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19763.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "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": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16464.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15984.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22858.41, "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": 13254, "minimum": 3310, "maximum": 21869.6115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21206.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19881.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14718.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12591.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "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": 13651.93, "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": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17628.23, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17230.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16567.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15907.95 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11928.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14049.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20544.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13917.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20544.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13917.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17230.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21869.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13254.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20243.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13254.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "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": 13254.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13651.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18953.66, "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": 6115, "minimum": 3310, "maximum": 10090.7895, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3960.23 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "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": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6299.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8745.35, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 9785.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9173.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 6727.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5153.47 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5809.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "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": 6299.1, "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": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8133.79, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7950.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7644.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 5765.73 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5504.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6482.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9479.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6421.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6421.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 7950.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10090.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6115.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8300, "minimum": 3310, "maximum": 14260, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13281.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12451.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9130.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7796.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7885.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "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": 8549.7, "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": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11039.9, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10790.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10375.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8870.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7470.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8798.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000, "10th_percentile": 9000, "90th_percentile": 22500, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12866.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8715.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12866.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8715.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10790.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13696.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5015.71 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "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": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8549.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11869.97, "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": 12246, "minimum": 3310, "maximum": 21160, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19594.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18369.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13471.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13258.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11634.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "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": 12613.79, "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": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16287.69, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15920.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15308, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14475.94 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11021.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12981.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18981.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12858.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18981.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12858.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15920.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20206.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12246.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11144.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12246.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "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": 12246.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12613.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12246.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17512.32, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13353, "minimum": 3310, "maximum": 22034.0175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21366.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20031, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14689.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13877.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12686.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "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": 13754.62, "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": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17760.75, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17360.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16692.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16049.52 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12018.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14155.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20698.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14021.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20698.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14021.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17360.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22034.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13353.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14594.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13353.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "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": 13353.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13754.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19096.15, "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": 36673, "minimum": 3310, "maximum": 65000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 58677.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55009.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 40340.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 46300.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34839.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "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": 37773.5, "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": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48775.5, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47675.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45841.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 49180.31 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33005.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38873.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56843.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 38506.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56843.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38506.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 47675.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 60510.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36673.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38682.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 36673.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "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": 36673.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 37773.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 36673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52442.83, "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": 8603, "minimum": 3310, "maximum": 14196.468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13766.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12905.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9464.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8014.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8173.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "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": 8862.04, "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": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11443.21, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11185.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10754.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9300.94 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7743.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9120.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13336.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9034.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9034.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11185.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14196.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7782.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "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": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8862.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8603.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12303.61, "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": 13882, "minimum": 3310, "maximum": 22905.7785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22211.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20823.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15270.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13188.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "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": 14298.77, "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": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18463.45, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18046.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17352.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16800.16 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12494.06, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14715.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14576.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21517.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14576.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18046.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22905.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13882.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13882.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "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": 13882.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14298.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13882.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19851.67, "additional_payer_notes": "143.00% 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": 53173, "minimum": 3310, "maximum": 87736.605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 85077.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 79760.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 58491.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50515.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "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": 54768.91, "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": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 70721.02, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 69125.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66467.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 72623.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 47856.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56364.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 82419.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 55832.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 82419.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 55832.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 69125.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 87736.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57181.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "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": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 54768.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 53173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76038.39, "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": 8930, "minimum": 3310, "maximum": 14735.8365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14289.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13396.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9823.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8484.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "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": 9198.73, "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": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11877.98, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11610.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11163.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9765.38 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8037.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9466.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9377.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13842.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9377.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11610.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14735.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8723.92 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "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": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8930.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12771.06, "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": 16553, "minimum": 3310, "maximum": 27313.077, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26485.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24830.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18208.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19567.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15725.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "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": 17050, "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": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22016, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21519.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20691.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20595.09 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14898.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17546.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25657.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17381.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25657.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17381.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21519.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 27313.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16553.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17131.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16553.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "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": 16553.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17050, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16553.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23671.33, "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": 35166, "minimum": 3310, "maximum": 58024.6095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 56266.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 52749.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 38683.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33408.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "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": 36221.39, "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": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46771.35, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45716.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43958, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 47039.42 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 31649.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37276.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54507.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36924.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54507.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36924.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 45716.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 58024.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35166.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47045.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 35166.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "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": 35166.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 36221.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 35166.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50287.99, "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": 36498, "minimum": 3310, "maximum": 60222.3435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 58397.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54747.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 40148.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 52597.92 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34673.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "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": 37593.35, "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": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48542.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47447.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45623, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 48931.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 32848.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38688.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56572.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 38323.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56572.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38323.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 47447.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 60222.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36498.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44676.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 36498.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "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": 36498.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 37593.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 36498.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52192.7, "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": 15609, "minimum": 3310, "maximum": 25756.4505, "payers_information": [ { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25756.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24359.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15609.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "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": 15609.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16078.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22322.26, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24975.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23415, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17170.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18377.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14829.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "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": 16078.3, "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": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20761.26, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20292.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19512.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19254.74 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14048.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16546.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24195.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16390.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24195.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16390.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20292.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15610, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17021, "minimum": 3310, "maximum": 28085.4915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27234.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25532.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18723.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20846.47 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16170.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "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": 17532.15, "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": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22638.61, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22127.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21276.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21260.17 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15319.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18042.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26383.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17872.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26383.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17872.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22127.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28085.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17021.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13653.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17021.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "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": 17021.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17532.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17021.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24340.76, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7218, "minimum": 3310, "maximum": 11911.2015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11550.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10828.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7940.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6652.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6857.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "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": 7435.48, "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": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9601.15, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9384.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7333.2 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6497.02, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7652.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11189.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7579.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11189.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7579.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9384.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11911.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5755.07 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "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": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7435.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10323.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57101, "minimum": 3310, "maximum": 94217.442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 91362.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 85652.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 62811.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 74340.52 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54246.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "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": 58814.55, "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": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 75944.97, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 74231.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 71376.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 78203.49 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 51391.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60527.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88507.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 59956.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88507.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 59956.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 74231.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 94217.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57101.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66796.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 57101.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "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": 57101.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 58814.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 57101.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81655.12, "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": 12408, "minimum": 3310, "maximum": 20473.8435, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13028.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16130.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20473.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12408.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9031.26 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12408.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "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": 12408.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12780.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17744, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19853.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18612.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13649.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13717.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11787.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "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": 12780.65, "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": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16503.16, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16130.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15510.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14706.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12408.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11167.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13152.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19233, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13028.82, "additional_payer_notes": "105.00% 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": 13741, "minimum": 3310, "maximum": 22673.9535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21986.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20612.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15115.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15764.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13054.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "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": 14154.05, "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": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18276.58, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17864.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17177.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16600.53 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12367.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14566.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21299.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14428.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21299.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14428.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17864.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22673.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13741.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14794.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13741.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "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": 13741.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14154.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13741.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19650.76, "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": 11435, "minimum": 3310, "maximum": 18868.7235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18296.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17153.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12579.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12322.56 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10863.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "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": 11778.67, "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": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15209.33, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14866.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14294.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13324.02 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10292.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12121.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17725.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12007.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17725.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12007.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14866.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18868.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11435.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7935.39 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11435.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "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": 11435.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11778.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11435.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16352.89, "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": 27596, "minimum": 3310, "maximum": 45534.885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 44155.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41395.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 30356.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 33459.74 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26217.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "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": 28424.81, "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": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36703.88, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35875.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34496.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 36285.08 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24837.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29252.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42775.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 28976.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42775.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28976.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 35875.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 45534.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34151.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "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": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28424.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 27596.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39463.57, "additional_payer_notes": "143.00% 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": 49194, "minimum": 3310, "maximum": 81170.6115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 78710.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 73791.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 54113.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 47466.59 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46734.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "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": 50670.13, "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": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 65428.43, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63952.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 61492.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 66969.43 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 44274.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52145.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 76251.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 51654.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76251.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 51654.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 63952.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 81170.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57987.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "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": 49194.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 50670.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 49194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70347.86, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 311625, "minimum": 3310, "maximum": 514182.438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 498601.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 467439, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 342788.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 344509.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 296044.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "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": 320974.78, "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": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 414462.21, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 405113.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 389532.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 439816.82 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 280463.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 330323.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 483019.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 327207.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 483020.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 327207.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 405113.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 514182.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 311625.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 318947 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 311625.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "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": 311625.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 320974.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 311626, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 445624.78, "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": 38189, "minimum": 3310, "maximum": 63012.675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 61103.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57284.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 42008.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 42013.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36280.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "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": 39335.19, "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": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50792.04, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49646.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47736.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 51334.44 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34370.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40480.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 59193.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 40098.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 59193.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40098.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 49646.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 63012.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38315 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "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": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 39335.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 38189.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54610.99, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19194, "minimum": 3310, "maximum": 31670.7105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 30710.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28791.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21113.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 21569.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18234.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "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": 19770.23, "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": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25528.51, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24952.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23993, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24347.24 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17274.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20346.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29751.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20154.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29751.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20154.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 24952.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 31670.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19194.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24139.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19194.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "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": 19194.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19770.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19194.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27447.95, "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": 7165, "minimum": 3310, "maximum": 11822.481, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6448.63, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7595.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11105.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7523.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11105.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7523.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9314.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11822.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5837.61 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "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": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7380.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10246.15, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11464.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10747.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7881.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5718.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6806.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "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": 7380.09, "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": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9529.64, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9314.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8956.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7256.81 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7165.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 10 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "44567070810", "type": "NDC" }, { "code": "J0690", "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, "median_amount": 12, "10th_percentile": 12, "90th_percentile": 12, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17129, "minimum": 3310, "maximum": 28264.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27407.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25694.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18842.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 21002.44 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16273.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "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": 17643.69, "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": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22782.58, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22268.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21412.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21413.96 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15416.78, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18157.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26551.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17986.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26551.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17986.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22268.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28264.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17129.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20776.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17129.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "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": 17129.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17643.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17129.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24495.56, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "60505623100", "type": "NDC" }, { "code": "J0690", "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, "median_amount": 12, "10th_percentile": 12, "90th_percentile": 12, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13961, "minimum": 3310, "maximum": 23035.8975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22337.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20941.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15357.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15979.09 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13263.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "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": 14380.04, "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": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18568.33, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18149.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17451.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16912.19 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12565.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14798.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21639.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14659.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21639.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14659.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18149.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23035.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13961.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16204.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13961.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "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": 13961.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14380.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19964.44, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00409080501", "type": "NDC" }, { "code": "J0690", "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, "median_amount": 12, "10th_percentile": 12, "90th_percentile": 12, "count": "1 through 10" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44839.3293, "maximum": 65000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 56279.36 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35228.223, "maximum": 65000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 44216.14 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16123, "minimum": 3310, "maximum": 26604.5505, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25798.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24186, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17736.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17379.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15317.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "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": 16607.72, "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": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21444.88, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20961.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20155, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19985.01 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14511.57, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17091.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24992.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16930.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24992.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16930.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20961.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26604.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16123.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13145.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16123.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "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": 16123.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16607.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16124, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23057.28, "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": 19558, "minimum": 3310, "maximum": 65000, "payers_information": [ { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18580.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "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": 20145.26, "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": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26012.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25426.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24448.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24864.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17602.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20732.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30315.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20536.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30315.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20536.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 25426.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 32271.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19558.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20688 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19558.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "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": 19558.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20145.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27968.71, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31293.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29337.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21514.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23443.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19558.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6992, "minimum": 3310, "maximum": 11537.4105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11187.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10488.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7691.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6380.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6642.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "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": 7202.14, "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": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9299.85, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9090.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8740.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7011.35 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6293.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7411.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10838.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7341.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10838.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7341.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9090.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11537.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5278.26 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "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": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7202.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6992.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9999.09, "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": 8100, "minimum": 3310, "maximum": 13366.1055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12961.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12151.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8910.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8150.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7695.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "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": 8343.69, "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": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10773.89, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10530.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10125.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8585.96 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7290.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8586.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12556.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8505.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12556.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8505.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10530.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13366.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7054.65 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "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": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8343.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8100.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11583.96, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9657, "minimum": 3310, "maximum": 15934.0665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15451.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14485.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10622.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9174.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "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": 9946.72, "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": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12843.82, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12554.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12071.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10797.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8691.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10236.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10139.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14968.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10139.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12554.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15934.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8064.47 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "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": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9946.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9657.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13809.52, "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": 16166, "minimum": 3310, "maximum": 26675.5335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25867.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24250.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17783.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17369.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15358.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "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": 16652.01, "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": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21502.1, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21017.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20208.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20046.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14550.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17137.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25058.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16975.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25058.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16975.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21017.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26675.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17395.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "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": 16166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16652.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16167, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23118.8, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10325, "minimum": 3310, "maximum": 17037.669, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16521.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15488.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11358.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11135.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9809.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "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": 10635.68, "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": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13733.39, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13423.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12907.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11747.38 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9293.27, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10945.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16005.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10842.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16005.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10842.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13423.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17037.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10325.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11036 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10325.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "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": 10325.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10635.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10325.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14765.98, "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": 8051, "minimum": 3310, "maximum": 13285.668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12883.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12077.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8857.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7687.76 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7649.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "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": 8293.48, "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": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10709.05, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10467.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10064.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8516.7 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8535.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12480.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8454.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12480.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8454.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10467.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13285.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7095.92 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "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": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8293.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11514.25, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10063, "minimum": 3310, "maximum": 16604.742, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16101.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15095.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11069.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9560.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "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": 10365.41, "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": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13384.43, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13082.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12579.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11374.61 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9057.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10667.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10566.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15598.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10566.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13082.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16604.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11936.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10063.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "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": 10063.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10365.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14390.78, "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": 8146, "minimum": 3310, "maximum": 13441.8075, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9496.64 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7739.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "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": 8390.95, "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": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10834.91, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10590.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10183.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8651.14 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7331.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8635.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12627.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8553.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12627.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8553.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10590.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13441.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6399.59 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "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": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8390.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11649.57, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13034.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12219.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8961.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8146.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25738, "minimum": 3310, "maximum": 42467.766, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 41180.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38607, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 28311.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 34630.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24451.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "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": 26510.14, "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": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34231.59, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33459.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32172.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 33644.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23164.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27282.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39893.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 27024.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39893.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27024.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 33459.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 42467.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25738.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26671.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 25738.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "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": 25738.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26510.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 25738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36805.4, "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": 23177, "minimum": 3310, "maximum": 65000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 37083.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34765.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 25495.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 28177.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22018.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "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": 23872.62, "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": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30825.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30130.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28971.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30006.03 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 20859.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24567.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35924.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 24336.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35924.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24336.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 30130.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 38242.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23177.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24212.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 23177.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "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": 23177.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23872.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 23177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33143.6, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62489, "minimum": 3310, "maximum": 103107.741, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 99983.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 93734.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 68738.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 78356.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59365.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "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": 64364.19, "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": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83111.09, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 81236.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 78111.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 85858.53 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 56240.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66238.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 96858.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 65613.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 96858.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 65614.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 81236.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 103107.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52021.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 62489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "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": 62489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 64364.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 62489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89360.04, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7796, "minimum": 3310, "maximum": 12864.5715, "payers_information": [ { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8576.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7090.64 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7406.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "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": 8030.61, "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": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10369.62, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10135.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9745.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8154.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7017.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8264.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12084.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8186.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12084.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8186.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10135.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12864.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5206.26 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "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": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12474.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7796.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9446, "minimum": 3310, "maximum": 15587.5005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15115.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14170.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10391.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9398.81 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8974.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "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": 9730.38, "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": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12564.47, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12281.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11808.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10498.7 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8502.27, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10013.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14642.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9919.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9919.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12281.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15587.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8227.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "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": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9446.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13509.17, "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": 17920, "minimum": 3310, "maximum": 29568.7755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28672.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8066 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26880.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19712.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20433.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17024.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "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": 18458.12, "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": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23834.23, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23296.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22400.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22537.37 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16128.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18995.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 24300, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000, "10th_percentile": 18000, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27776.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18816.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27776.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18816.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 23296.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 29568.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17920.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17899.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17920.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "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": 17920.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18458.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17920.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25626.27, "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": 19657, "minimum": 3310, "maximum": 32434.8255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31451.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21623.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18674.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "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": 20247.23, "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": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26144.44, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25554.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24571.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25005.19 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17691.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20836.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20640.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30469.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20640.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 25554.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 32434.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19657.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12781.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19657.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "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": 19657.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20247.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28110.18, "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": 24346, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 38954.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36519.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 26781.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 28222.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23129.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "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": 25077, "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": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32380.94, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31650.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30433.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 31667.2 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21911.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25807.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37737.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25563.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37737.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25563.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 31650.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 40171.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24346.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24939.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 24346.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "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": 24346.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25077, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 24346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34815.6, "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": 9629, "minimum": 3310, "maximum": 15887.9325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15406.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14443.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10591.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9492.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9147.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "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": 9917.92, "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": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12806.64, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12517.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12036.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10757.4 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8666.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10206.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14925.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10110.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14925.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10110.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12517.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15887.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8862.66 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "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": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9917.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9629.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13769.54, "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": 8923, "minimum": 3310, "maximum": 14724.006, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14277.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13385.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9816, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11241 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8477.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "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": 9191.35, "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": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11868.44, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11600.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11154.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9755.19 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8031.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9459.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9369.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13831.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9369.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11600.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14724.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6691.13 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "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": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9191.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8923.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12760.81, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Claviculectomy Partial", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38294.4, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 30635.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2172.99 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2150.58 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2240.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "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": 19848, "minimum": 3310, "maximum": 32749.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31757.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29772.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21832.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23067.89 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18855.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "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": 20443.65, "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": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26398.05, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25802.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24810.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25276.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17863.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21039.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30764.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20840.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 25802.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 32749.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19848.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21284.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19848.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "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": 19848.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20443.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19848.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28382.87, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32425.96, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 25940.768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1894.01 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1874.48 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1952.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20642, "minimum": 3310, "maximum": 34060.059, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 33027.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30963.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22706.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 24640.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19610.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "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": 21261.78, "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": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27454.47, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26835.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25803.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26404.61 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18578.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21881.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31995.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21674.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31995.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21674.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 26835.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 34060.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20642.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13693.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20642.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "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": 20642.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21261.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 20642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29518.72, "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": 41218, "minimum": 3310, "maximum": 68010.228, "payers_information": [ { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54820.37, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53583.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51522.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 55637.6 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 37096.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43691.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 63888.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 43279.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63888.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43279.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 53583.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 68010.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41218.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56518.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41218.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "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": 41218.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 42454.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58942.2, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 65949.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 61827.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 45340.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 49074.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39157.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41218.3, "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": 42454.85, "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": 41218.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44128, "minimum": 3310, "maximum": 72811.4145, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 70605.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 66192.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 48540.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 55652.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41921.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "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": 45451.94, "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": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 58690.41, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57366.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55160.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 59771.69 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 39715.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46775.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 68398.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 46334.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68398.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 46334.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 57366.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 72811.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44128.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53102.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 44128.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "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": 44128.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 45451.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 44128.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63103.23, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12991, "minimum": 3310, "maximum": 21436.6845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20787.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19487.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14291.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14256.04 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12342.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "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": 13381.66, "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": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17279.27, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16889.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16239.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15535.18 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11692.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13771.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20137.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13641.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20137.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13641.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16889.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21436.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12991.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10985.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12991.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "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": 12991.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18578.46, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 738, "minimum": 216.8, "maximum": 20123.2, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1774.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1332.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1973.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1973.17 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 554.51 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 548.8 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 571.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% 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": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 216.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 826.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 1342.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 216.8 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65000, "maximum": 84847.7344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65000 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 84847.73 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16873, "minimum": 3310, "maximum": 27840.6315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26996.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25309.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18560.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18752.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16029.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "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": 17379.29, "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": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22441.24, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21935.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21091.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21049.34 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15185.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17885.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26153.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17716.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26153.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17716.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21935.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 27840.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16873.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19715.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16873.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "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": 16873.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17379.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24128.55, "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": 24646, "minimum": 3310, "maximum": 40666.2795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 39433.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36969.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27110.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23413.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "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": 25385.59, "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": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32779.49, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32040.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30807.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32092.94 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22181.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26124.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38201.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25878.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25878.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 32040.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 40666.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24646.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35008.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 24646.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "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": 24646.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25385.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 24646.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35244.11, "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": 9242, "minimum": 3310, "maximum": 15250.3725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14788.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13863.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10166.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9480.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8780.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "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": 9519.93, "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": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12292.72, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12015.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11553.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10208.43 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8318.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9797.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14326.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9704.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14326.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9704.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12015.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15250.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7252.23 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "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": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9519.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9242.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13216.99, "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": 11830, "minimum": 3310, "maximum": 19950.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18928.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17745.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13013.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13125.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11239.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "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": 12185.52, "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": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15734.68, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15379.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14788.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13885.21 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10647.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12540.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18337.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12422.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18337.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12422.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15379.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19520.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11830.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19950.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11830.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "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": 11830.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12185.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16917.74, "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": 25072, "minimum": 3310, "maximum": 41368.899, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40115.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37608.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27579.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23818.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "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": 25824.26, "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": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33345.84, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32593.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31340.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32697.92 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22564.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26576.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38861.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 26325.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38861.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26325.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 32593.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 41368.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27896.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 25072.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "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": 25072.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25824.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 25072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35853.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7136, "minimum": 3310, "maximum": 11775.159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11418.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7850.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6052.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6779.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "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": 7350.55, "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": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9491.49, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9277.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8920.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7216.07 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6422.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7564.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11061.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7493.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11061.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7493.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9277.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11775.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5117.57 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "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": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7350.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7136.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10205.14, "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": 15182, "minimum": 3310, "maximum": 25050.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24291.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22773, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16700.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16929.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14422.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "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": 15637.46, "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": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20192.06, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19736.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18977.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18646.7 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13663.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16092.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23532.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15941.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23532.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15941.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 19736.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25050.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12520.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "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": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15637.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21710.26, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Correct Metacarpal Flaw", "code_information": [ { "code": "26565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39624.1, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 31699.28, "payers_information": [ { "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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2688.7 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2660.99 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2771.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7958, "minimum": 3310, "maximum": 13131.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12733.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11938.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8754.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7888.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7560.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "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": 8197.48, "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": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10585.1, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10346.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9948.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8384.29 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7162.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8436.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12336.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8356.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12336.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8356.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10346.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13131.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10942.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "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": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7958.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11380.97, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13558, "minimum": 3310, "maximum": 22371.129, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21693.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20337.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14914.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13376.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12880.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "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": 13965.05, "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": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18032.49, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17625.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16947.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16339.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12202.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14371.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21015.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14236.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21015.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14236.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17625.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22371.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13558.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13213.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13558.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "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": 13558.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13965.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19388.31, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9998, "minimum": 3310, "maximum": 16497.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15997.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14997.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10998.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10372.47 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9498.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "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": 10298.19, "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": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13297.66, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12997.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12497.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11281.92 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8998.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10598.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15497.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10498.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15497.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10498.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12997.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16497.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7929.24 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "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": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10298.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9998.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14297.48, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34651, "minimum": 3310, "maximum": 57175.3215, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 57175.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34651.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37515.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 34651.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "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": 34651.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 35691.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49551.95, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 55442.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51977.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 38116.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 41453.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32919.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "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": 35691.25, "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": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46086.77, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45047.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43314.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 46308.14 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 31186.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36730.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53710.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53710.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36384.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 45047.22, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6659, "minimum": 3310, "maximum": 10988.571, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10655.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9989.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7325.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6413.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6326.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "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": 6859.53, "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": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8857.45, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8657.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8324.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6538.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5993.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7059.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10322.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6992.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10322.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6992.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8657.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10988.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4396.65 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "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": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6659.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9523.43, "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": 30100, "minimum": 3310, "maximum": 49666.584, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 48161.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45151.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 33111.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 36293.04 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28595.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "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": 31004.03, "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": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40034.28, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39131.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37626.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39842.7 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 27090.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31907.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46656.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 31606.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46656.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31606.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 39131.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 49666.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30100.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34230.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 30100.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "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": 30100.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 31004.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 30101, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43044.37, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323016501", "type": "NDC" }, { "code": "J1100", "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, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "count": "1 through 10" } ] } ] }, { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43241.6, "discounted_cash": 12833, "minimum": 1900, "maximum": 34593.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21176.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17710.89, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14117.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21355.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16031.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12192.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "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": 13219, "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": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2219.79 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13604.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2196.9 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19892.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19892.67, "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": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2288.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 21176.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "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": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 3508.38 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 13366.93 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 17937.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3508.38 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% 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": 9728, "minimum": 3310, "maximum": 16052.355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15565.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8066 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14593.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10701.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10613.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9242.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "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": 10020.56, "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": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12939.17, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12647.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12160.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10898.97 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8755.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10312.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15079.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10215.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15079.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10215.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12647.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16052.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10643.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "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": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10020.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13912.04, "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": 56864, "minimum": 3310, "maximum": 93825.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 90982.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 85296.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 62550.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 71918.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54020.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "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": 58570.13, "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": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 75629.39, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 73923.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 71080.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 77866.36 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 51177.78, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60276.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88139.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 59707.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88139.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 59707.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 73923.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 93825.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68908.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "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": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 58570.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 56864.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81315.81, "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": 45518, "minimum": 3310, "maximum": 75106.1355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 72830.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68278.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 50070.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 54435.41 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43242.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "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": 46884.47, "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": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 60540.1, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 59174.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56898.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 61747.58 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40966.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48250.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 70554.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 47794.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 70554.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 47794.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 59174.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 75106.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45518.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59541.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 45518.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "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": 45518.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 46884.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 45518.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65091.98, "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": 16746, "minimum": 3310, "maximum": 27632.451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 26795.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25120.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18421.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16556.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15909.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "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": 17249.31, "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": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22273.43, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21771.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20933.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20870.08 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15072.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17751.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25957.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17584.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25957.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17584.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 21771.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 27632.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16746.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13385.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16746.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "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": 16746.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17249.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16746.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23948.12, "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": 32086, "minimum": 3310, "maximum": 52941.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 51337.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48778 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48129, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 35294.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 37661.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30481.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "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": 33048.58, "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": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42674.38, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41711.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40107.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 42662.93 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28877.4, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34011.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49733.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 33690.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49733.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33690.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 41711.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 52941.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42918 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "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": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 33048.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 32086, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45882.98, "additional_payer_notes": "143.00% 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": 10211, "minimum": 3310, "maximum": 16849.5855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16338.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15317.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11233.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10802.54 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9701.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "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": 10518.26, "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": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13581.79, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13275.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12764.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11585.44 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9190.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10824.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15828.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10722.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15828.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10722.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13275.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16849.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10211.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3819.73 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10211.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "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": 10211.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10211.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14602.97, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33079, "minimum": 3310, "maximum": 54581.3235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 52927.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49619.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 36387.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31425.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "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": 34071.99, "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": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43995.85, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43003.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41349.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 44074.57 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29771.63, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35064.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51273.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 34733.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51273.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 34733.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 43003.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 54581.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46442.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 33079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "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": 33079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34071.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 33079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47303.81, "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": 9824, "minimum": 3310, "maximum": 16210.854, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15719.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14737.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10807.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9779.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9333.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "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": 10119.5, "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": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13066.93, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12772.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12280.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11035.45 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8842.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10414.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15228.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10316, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15228.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10316, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12772.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16210.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8816.12 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "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": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10119.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9824.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14049.41, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22921.5, "discounted_cash": 1650, "minimum": 486.45, "maximum": 18337.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4900.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3678.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5449.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5449.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 809.03 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 800.69 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% 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": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1278 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 486.45 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 1853.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2896.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 486.45 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "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 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 80011, "minimum": 3310, "maximum": 132018.975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 128018.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 120017.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 88012.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76010.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "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": 82411.85, "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": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 106415.3, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 104014.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 100014.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 110752.71 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 72010.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 84812.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 124017.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 84012.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 124017.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 84012.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 104014.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 132018.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 106182 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "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": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 82411.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 80011.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114416.45, "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": 9933, "minimum": 3310, "maximum": 16389.4665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15892.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14899.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10926.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9793.81 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9436.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "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": 10231, "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": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13210.9, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12912.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12416.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11189.24 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8939.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10528.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15396.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10429.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10429.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12912.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16389.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13357.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "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": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10231, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9933.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14204.2, "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": 11345, "minimum": 3310, "maximum": 18719.679, "payers_information": [ { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11685.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16223.72, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18152.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17017.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12479.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11667.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10778, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "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": 11685.66, "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": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15089.2, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14748.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14181.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13195.69 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10210.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12026.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17585.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11912.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17585.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11912.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14748.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18719.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11345.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14188.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11345.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "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": 11345.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11345.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11748, "minimum": 3310, "maximum": 19384.4475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18797.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17622.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12922.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13467.88 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11160.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "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": 12100.65, "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": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15625.04, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15272.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14685.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13768.08 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10573.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18209.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12335.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18209.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12335.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15272.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19384.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11748.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13750.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11748.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "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": 11748.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16799.85, "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": 7215.4989, "maximum": 11040, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9056.42 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7698.31 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13743, "minimum": 3310, "maximum": 22677.501, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21990.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20615.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15118.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14732.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13056.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "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": 14156.22, "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": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18279.44, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17867.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17179.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16603.59 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12369.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14568.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21303.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14431.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21303.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14431.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17867.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22677.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14335.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13743.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "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": 13743.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14156.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13743.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19653.83, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8802, "minimum": 1019, "maximum": 18000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14083.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13203.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9682.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8362.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "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": 9066.56, "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": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11707.31, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11003.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9583.07 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7922.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9330.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13643.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9242.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13643.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9242.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11443.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14524.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4028.72 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "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": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9066.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12587.56, "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": 6512, "minimum": 3310, "maximum": 10744.899, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10419.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9768.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7163.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5591.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6186.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "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": 6707.42, "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": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8661.04, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8465.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8140.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6328.96 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5860.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6902.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10093.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6837.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10093.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6837.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8465.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10744.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5029.76 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "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": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6707.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6512.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9312.25, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641036725", "type": "NDC" }, { "code": "J1100", "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, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "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": 9902, "minimum": 3310, "maximum": 16339.785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15844.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14854.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10893.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9937.79 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9407.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "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": 10199.99, "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": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13170.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12873.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12378.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11146.46 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8912.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10497.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15349.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10398.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15349.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10398.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12873.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 16339.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7714.11 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "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": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10199.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14161.15, "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": 18711, "minimum": 3310, "maximum": 30873.4635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 29937.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28066.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 20582.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20186.59 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17775.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "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": 19272.54, "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": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24885.88, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24324.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23389, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23660.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16840.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19833.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29002.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19646.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29002.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19646.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 24324.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 30873.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18711.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21246.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 18711.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "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": 18711.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19272.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 18711.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26757, "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": 8579, "minimum": 3310, "maximum": 14156.241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13727.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12869.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9437.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8205.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8150.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "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": 8836.93, "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": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11410.79, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11153.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10724.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9266.31 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7721.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9094.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13298.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9008.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13298.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9008.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11153.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14156.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7206.57 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "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": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8836.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8579.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12268.74, "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": 20143, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20143.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "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": 20143.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20747.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28805.22, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 32229.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30215.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 22157.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23181.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19136.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "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": 20747.81, "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": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26790.87, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26186.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25179.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25695.74 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18129.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21352.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31222.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 21150.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31222.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21150.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 26186.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 33236.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20143.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20143.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24898.5 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50311, "minimum": 3310, "maximum": 87896.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 80497.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 75466.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 55342.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 58031.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47795.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "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": 51820.54, "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": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66913.91, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 65404.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62889, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 68556.25 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 45280.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53329.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 77982.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 52826.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 77982.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 52826.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 65404.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 83013.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 87896.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 50311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "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": 50311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 51820.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 50311.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71945.03, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8482, "minimum": 3310, "maximum": 13995.3825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13571.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12723.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9330.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8115.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8057.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "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": 8736.51, "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": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11281.13, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11026.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10602.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9127.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7633.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8990.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13147.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8906.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13147.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8906.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11026.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13995.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5561.01 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "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": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8736.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8482.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12129.33, "additional_payer_notes": "143.00% 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": 43136, "minimum": 3310, "maximum": 71175.522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 69018.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64705.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 47450.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 52257.37 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40979.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "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": 44430.8, "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": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 57371.78, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56077.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53920.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 58363.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 38823.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45724.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66861.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 45293.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 66861.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 45293.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 56077.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 71175.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43136.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55579.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 43136.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "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": 43136.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 44430.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 43136.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61685.45, "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": 10728, "minimum": 3310, "maximum": 17702.421, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10077.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10728.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "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": 10728.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11050.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15342.1, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17165.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11801.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11120.02 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10192.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "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": 11050.56, "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": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14269.22, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13947.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13410.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12319.78 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9655.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11372.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16629.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11265.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16629.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11265.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13947.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17702.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10728.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10728.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17649.7, "discounted_cash": 306, "minimum": 27.96, "maximum": 14119.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 110.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 83.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 123.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 123.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 163.18 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 161.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 168.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% 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": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 27.96 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.05, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 106.53 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 142.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27.96 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12356, "minimum": 3310, "maximum": 20388.687, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19770.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18535.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13592.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12687.11 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11738.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "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": 12727.5, "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": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16434.52, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16063.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15446, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14632.79 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11121.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13098.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19153.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12974.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19153.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12974.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16063.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20388.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12356.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9390.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12356.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "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": 12356.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12356.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17670.2, "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": 17389, "minimum": 3310, "maximum": 28692.2955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27822.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26083.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19128.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19084.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16519.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "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": 17910.98, "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": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23127.73, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22606.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21736.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21782.66 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15650.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18432.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26953.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18258.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18258.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22606.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28692.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17389.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19079.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17389.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "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": 17389.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17910.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17389.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24866.66, "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": 8683, "minimum": 3310, "maximum": 14327.7585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13893.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13025.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9551.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8261.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8249.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "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": 8943.99, "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": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11549.04, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11288.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10854.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9414 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7815.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9204.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13459.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9117.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13459.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9117.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11288.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14327.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7800.16 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "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": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8943.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8683.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12417.39, "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": 11172, "minimum": 3310, "maximum": 18434.6085, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17875.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16758.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12289.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12007.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10613.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "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": 11507.68, "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": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14859.41, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14524.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13965.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12950.23 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10055.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11842.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17317.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11731.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11731.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14524.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18434.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10680.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11172.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "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": 11172.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11507.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11172.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15976.66, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Dilation of salivary duct", "code_information": [ { "code": "42660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10802.49, "discounted_cash": 539, "minimum": 57.03, "maximum": 8641.992, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 889.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 269.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 202.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 299.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 299.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "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": 555.3, "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": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 318.53 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 522.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 808.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 673.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 673.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 571.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 315.25 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 566.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.65, "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": 566.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 328.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 700.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 889.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "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": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.03 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 539.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 217.28 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 291.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.03 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1078.26, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9427.2813, "maximum": 15640, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11832.5 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11969.4 } ] } ] }, { "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": 8977, "minimum": 3310, "maximum": 14812.7265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14363.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9875.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8597.74 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8528.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "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": 9246.73, "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": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11939.96, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11670.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11221.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9831.58 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8079.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9516.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13914.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9426.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13914.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9426.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11670.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14812.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8189.16 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "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": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9246.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8977.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12837.7, "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": 14923, "minimum": 3310, "maximum": 24623.28, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17384.67 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14177.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "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": 15370.9, "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": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19847.86, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19400.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18654, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18279.02 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13430.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15818.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23130.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15669.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23130.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15669.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 19400.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 24623.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15880.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "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": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15370.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21340.18, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23877.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22384.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16415.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14923.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16153, "minimum": 1019, "maximum": 26653.0605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25845.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24230.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17768.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1019 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15345.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "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": 16638, "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": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21483.98, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20999.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20191.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20026.77 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14538.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17122.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25037.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16961.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25037.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16961.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20999.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26653.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16153.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10764.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16153.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "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": 16153.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16638, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16153.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23099.32, "additional_payer_notes": "143.00% 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": 7073, "minimum": 3310, "maximum": 11671.077, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11317.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10610.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7780.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6116.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6719.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "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": 7285.58, "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": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9407.6, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9195.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8841.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7126.44 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6366.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7497.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10963.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7427.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10963.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7427.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9195.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 11671.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5273.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "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": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7285.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7073.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10114.93, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14364, "minimum": 3310, "maximum": 23701.8375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22983.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21547.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15801.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14511.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13646.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "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": 14795.74, "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": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19105.12, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18674.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17956, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17485.61 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12928.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15226.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22265.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15083.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22265.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15082.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18674.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23701.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14364.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14192.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14364.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "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": 14364.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14795.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20541.59, "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": 7988, "minimum": 3310, "maximum": 13180.398, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7532.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7588.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "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": 8227.76, "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": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10624.2, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10384.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8426.05 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7189.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8467.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12381.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8387.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12381.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8387.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10384.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13180.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5881.52 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "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": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8227.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11423.01, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12780.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8786.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7988.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc legankle tum dep 5 cm>", "code_information": [ { "code": "27634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36062.78, "discounted_cash": 2903, "minimum": 815.2, "maximum": 28850.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8278.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6214.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2464.24 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2438.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2540.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% 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": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3105.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4167.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323050601", "type": "NDC" }, { "code": "J1100", "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, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "count": "1 through 10" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17236, "minimum": 3310, "maximum": 28440.3405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 27578.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25854.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 18960.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18763.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16374.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "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": 17753.7, "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": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22924.64, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22407.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21545.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21565.72 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15512.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18270.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26716.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18098.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26716.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18098.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 22407.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 28440.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12516.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17236.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "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": 17236.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17753.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17236.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24648.3, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Excision of mouth lesion - 40816 - ", "code_information": [ { "code": "40816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6604.01, "discounted_cash": 3314, "minimum": 427.9398, "maximum": 6604.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4573.65, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3645.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6604.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6604.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6604.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6604.01 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3148.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3413.67, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1127.26 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4971.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4639.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3513.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1115.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "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": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1162.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 4308.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3413.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3378.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4533.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6604.01, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Excision of mouth lesion - 41116 - ", "code_information": [ { "code": "41116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21592.7, "discounted_cash": 3314, "minimum": 795.61, "maximum": 17274.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4573.65, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3645.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9350.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10398.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10398.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3148.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3413.67, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 803.9 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4971.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4639.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3513.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 795.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "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": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 828.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 4308.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3413.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3378.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4533.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6628.48, "additional_payer_notes": "200.00% 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": 7771, "minimum": 3310, "maximum": 12823.173, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12434.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11657.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8548.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7256.76 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7383.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "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": 8004.77, "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": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10336.25, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10103.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9714.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8118.46 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6994.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8237.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12046.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8160.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12046.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8160.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10103.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12823.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7804.55 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "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": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8004.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7771.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11113.42, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11602, "minimum": 3310, "maximum": 19144.323, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 18564.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17403.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12762.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12225.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11022.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "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": 11950.68, "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": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15431.48, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15083.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14503.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13561.33 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10442.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12298.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17984.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12182.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17984.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12182.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15083.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19144.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11602.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13471.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11602.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "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": 11602.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16591.75, "additional_payer_notes": "143.00% 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": 155114, "minimum": 3310, "maximum": 255939.0735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 248183.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 232672.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 170626.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 147358.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "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": 159768.45, "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": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 206302.4, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 201648.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 193893.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 217454.84 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 139603.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 164421.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 240427.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 162870.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 240428.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 162870.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 201648.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 255939.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 155114.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 231224 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 155114.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "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": 155114.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 159768.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 155115, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 221813.86, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7319, "minimum": 3310, "maximum": 12076.7955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11710.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10978.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6801.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6953.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "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": 7538.85, "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": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9734.63, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9515.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9149.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7475.79 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6587.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7758.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11344.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7685.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11344.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7685.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9515.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12076.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4372.94 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "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": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7538.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7319.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10466.56, "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": 6510, "minimum": 3310, "maximum": 10742.5395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10417.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9765.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7161.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5623.23 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6185.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "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": 6705.95, "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": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8659.14, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8463.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8138.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6326.92 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5859.57, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6901.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10091.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6836.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10091.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6836.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8463.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10742.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4026.97 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "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": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6510.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9310.2, "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": 9405, "minimum": 3310, "maximum": 15640, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15048.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14108.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10345.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9397.89 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8935.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "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": 9687.55, "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": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12509.17, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12227.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11756.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10439.63 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8464.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9969.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14578.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9875.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14578.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9875.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12227.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15518.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7208.32 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "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": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9687.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9405.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13449.71, "additional_payer_notes": "143.00% 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": 45990, "minimum": 3310, "maximum": 75884.457, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "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": 47370.32, "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": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61167.47, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 59787.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57488.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 62417.75 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 41391.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48750.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 71285.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 48290.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 71285.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 48290.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 59787.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 75884.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45990.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36884.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 45990.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "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": 45990.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 47370.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65766.53, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 73584.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68985.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 50589.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 65500.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45990.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43691.05, "additional_payer_notes": "95.00% 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": 11149, "minimum": 3310, "maximum": 18396.7575, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17839.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16724.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12264.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11484.57 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10592.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "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": 11483.99, "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": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14828.9, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14494.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13936.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12917.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10034.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11818.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17281.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11706.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17281.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11707.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14494.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18396.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9094.48 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11149.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "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": 11149.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11483.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11149.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15943.86, "additional_payer_notes": "143.00% 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": 36186, "minimum": 3310, "maximum": 59707.791, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 57898.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54279.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 39805.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 51690.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34377.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "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": 37272.1, "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": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48128.1, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47042.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45233.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 48488.75 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 32567.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38357.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56089.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 37995.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56089.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 37995.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 47042.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 59707.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36186.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3553.67 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 36186.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "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": 36186.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 37272.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 36186.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51746.75, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 1650, "minimum": 486.45, "maximum": 16551.2, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 486.45 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "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 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4900.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3678.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5449.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5449.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1235.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1223.22 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1274.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2724.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% 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": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 486.45 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 1853.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2487.08 } ] } ] }, { "description": "Endovenous Rf 1St Vein", "code_information": [ { "code": "36475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33186.7, "discounted_cash": 3156, "minimum": 558.0058, "maximum": 26549.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9893.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7427.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11001.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11001.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 967.09 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 957.12 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 997 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% 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": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1118.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4260.42 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5717.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1118.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXCISION OF FACIAL BONE(S)", "code_information": [ { "code": "21026", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8267.94, "discounted_cash": 5917, "minimum": 535.76, "maximum": 8267.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8267.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8267.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8267.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8267.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1588.04 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5740.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7397.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6272.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1571.67 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1637.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% 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": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6095.19, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 7445.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 8267.94 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8267.94, "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": 13689, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21903.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20534.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15058.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15295.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13004.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "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": 14100.19, "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": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18206.97, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17796.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17111.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16526.18 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12320.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14510.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21218.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14373.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21218.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14373.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17796.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22587.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13689.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17594.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13689.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "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": 13689.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14100.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13689.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.91, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exploration Of Spinal Fusion", "code_information": [ { "code": "22830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26557.5, "discounted_cash": 7253, "minimum": 1720.926, "maximum": 26557.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7978.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3038.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2281.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3379.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3379.42 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2953.68 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2923.23 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3045.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% 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": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% 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": 14507.12, "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": 29974, "minimum": 3310, "maximum": 49457.2155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 47958.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44961.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 32971.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28475.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "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": 30873.32, "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": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39865.51, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38966.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37467.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39662.43 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 26976.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31772.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46459.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 31472.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46459.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31472.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 38966.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 49457.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29974.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42174.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 29974.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "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": 29974.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 30873.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 29974.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42862.92, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8087, "minimum": 3310, "maximum": 13800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12940.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12131.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8896.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7792.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7683.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "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": 8330.39, "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": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10756.72, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10514.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10109.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8567.62 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7278.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8573.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12536.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8492.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8492.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10514.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13344.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6692 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "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": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8087.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11565.5, "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": 14035, "minimum": 3310, "maximum": 23158.9215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22457.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21053.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15439.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15401.36 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13333.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "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": 14456.77, "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": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18667.49, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18246.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17544.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17018.12 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12632.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14877.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21755.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14737.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21755.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14737.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18246.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23158.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14035.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11758.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14035.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "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": 14035.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14456.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14035.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20071.07, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32426, "discounted_cash": 2903, "minimum": 815.2, "maximum": 25940.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2529.05 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2502.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2607.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% 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": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3105.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4167.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8278.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6214.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9205.99 } ] } ] }, { "description": "EXCISE MAXZYGOMA B9 TUMOR", "code_information": [ { "code": "21030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3977.95, "discounted_cash": 5917, "minimum": 231.72, "maximum": 3977.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1120.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 841.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1246.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1246.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "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": 3977.95, "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": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1341.5 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1327.67 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "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": 3977.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1382.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "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": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.72 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 882.85 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 1184.72 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.72 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3977.95, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXCISION OF BONE LOWER JAW", "code_information": [ { "code": "21025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32778.28, "discounted_cash": 5917, "minimum": 1900, "maximum": 26222.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9764.14, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17316.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12999.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19256.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19256.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2442.01 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5740.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8876.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7397.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6272.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2416.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9172.37, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2517.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9764.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5917.66, "additional_payer_notes": "100.00% 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": 5917.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6095.19, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 7445.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 9991.38 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11835.32, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Excision of gum lesion", "code_information": [ { "code": "41825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6604.01, "discounted_cash": 3314, "minimum": 139.54, "maximum": 6604.01, "payers_information": [ { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4971.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4639.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3513.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 446.9 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "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": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 465.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 4308.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 139.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3413.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 531.65 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 713.43 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 139.54 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6604.01, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4573.65, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3645.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 599.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 449.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 666.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 666.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3148.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3413.67, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 451.55 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25657, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 41052.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38486.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 28223.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 30222.21 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24374.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "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": 26427.53, "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": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34124.81, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33355.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32072.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 33530.04 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23091.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27197.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39769.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 26940.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39769.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26940.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 33355.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 42335.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25657.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40015.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 25657.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "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": 25657.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26427.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 25657.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36690.58, "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": 12271, "minimum": 3310, "maximum": 20247.9255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19634.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18407.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13498.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12994.43 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11657.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "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": 12639.65, "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": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16321.06, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15952.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15339.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14511.59 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11044.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13007.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19020.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12885.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19020.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12885.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15952.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20247.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12271.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11426.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12271.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "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": 12271.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12639.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12271.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17548.2, "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": 10484, "minimum": 3310, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 16774.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45000 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15726.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 11532.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10511.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9960.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "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": 10798.83, "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": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13944.11, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13629.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13105.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11972.47 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9435.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11113.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16250.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11008.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16250.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11008.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 13629.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 17299.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10484.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14376.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10484.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "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": 10484.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 10484.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14992.53, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35691, "minimum": 3310, "maximum": 58891.635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 57107.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53537.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 39261.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 42525.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33907.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "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": 36762.66, "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": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47470.23, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 46399.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44614.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 47785.98 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 32122.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37833.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55322.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 37476.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55322.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 37476.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 46399.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 58891.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49154.3 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "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": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 36762.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 35691.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51039.42, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7445, "minimum": 3310, "maximum": 12284.976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 11912.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11168.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8189.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6787.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7073.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "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": 7668.8, "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": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9902.44, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9679.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9306.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7655.05 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6700.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7892.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11540.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7817.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11540.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7817.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9679.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12284.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6743.81 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "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": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7668.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7445.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10646.98, "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": 7846, "minimum": 3310, "maximum": 12947.3685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12555.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11770.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8631.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7121.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7454.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "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": 8082.3, "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": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10436.36, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10200.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9808.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8225.41 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7062.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8317.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12162.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8239.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12162.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8239.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10200.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12947.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5596.13 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "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": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8082.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7846.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11221.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13060, "minimum": 3310, "maximum": 21550.2375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20897.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19591.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14366.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13412.51 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12407.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "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": 13452.62, "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": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17370.8, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16978.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16326, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15632.96 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11754.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13844.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20244.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13713.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20244.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13713.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16978.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21550.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20446.6 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13060.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "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": 13060.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18676.87, "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, "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, "median_amount": 33.68, "10th_percentile": 33.68, "90th_percentile": 50.52, "count": "1 through 10" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31948, "minimum": 3310, "maximum": 52714.794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 51117.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 47922.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 35143.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30350.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "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": 32906.85, "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": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42491.32, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41532.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39935.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 42467.38 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28753.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33865.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49519.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 33545.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49520.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 33545.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 41532.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 52714.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31948.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40649.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 31948.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "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": 31948.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 32906.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 31948.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45686.15, "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": 44665, "minimum": 3310, "maximum": 80550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 71464.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 66997.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 49131.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42431.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "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": 46005.05, "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": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59404.54, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58064.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55831.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 60534.55 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40198.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47345.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69230.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 46898.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69230.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 46898.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 58064.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 73697.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44665.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6449.64 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 44665.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "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": 44665.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 46005.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 44665.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63871.05, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39761.6, "discounted_cash": 7253, "minimum": 1900, "maximum": 31809.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.91, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7978.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21355.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16031.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23748.34 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2127.19 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2105.26 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2192.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% 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": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 3471.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 13226.34 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 17748.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3471.48 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Finger Joint", "code_information": [ { "code": "26860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28771.5, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 23017.2, "payers_information": [ { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2395.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2323.74 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2299.79 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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" } ] } ] }, { "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": 154216, "minimum": 3310, "maximum": 254456.961, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 246746.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 231324, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 169637.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 175269.78 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 146505.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "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": 158842.48, "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": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 205107.73, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 200481.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 192770, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 216178.66 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 138794.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 163468.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 239035.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 161926.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 239034.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 161927.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 200481.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 254456.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 154216.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 227028 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 154216.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "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": 154216.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 158842.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 154216, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 220529.37, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fusion/Graft Of Finger Joint", "code_information": [ { "code": "26862", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43241.6, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 34593.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2882.33 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2852.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2971.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13857, "minimum": 3310, "maximum": 23000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22172.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20786.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15243.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15350.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "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": 14273.64, "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": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18431.03, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18015.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17322.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16765.53 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12472.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14689.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21479.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14550.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21479.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14550.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18015.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22865.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13857.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13018.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13857.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "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": 13857.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14273.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13857.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19816.83, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15457, "minimum": 3310, "maximum": 25504.512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24731.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23185.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17003.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16371.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14684.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "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": 15921.02, "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": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20558.18, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20094.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19321.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19037.8 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13911.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16384.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23958.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16230.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23958.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16230.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20094.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25504.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16713.8 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "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": 15457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15921.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15457.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22103.91, "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": 12002, "minimum": 3310, "maximum": 19804.356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 19204.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18003.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13202.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12443.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11402.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "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": 12362.68, "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": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15963.51, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15603.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15003.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14129.65 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10802.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12722.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18604.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12602.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18604.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12602.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 15603.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 19804.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12002.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16932.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12002.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "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": 12002.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12362.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12002.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17163.78, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7565, "minimum": 3310, "maximum": 12482.514, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12104.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11347.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8321.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7086.03 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7186.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "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": 7792.11, "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": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10061.66, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9834.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9456.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7825.14 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6808.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8019.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11726, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7943.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11726, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7943.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9834.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12482.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4522.21 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "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": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7565.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10818.18, "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": 15161, "minimum": 3310, "maximum": 25017.168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 24259.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22742.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16678.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16602.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14403.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "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": 15616.76, "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": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20165.35, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19710.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18952.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18618.18 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13645.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16071.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23500.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15920, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23500.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15920.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 19710.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 25017.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15161.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14875.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15161.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "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": 15161.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15616.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 15161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21681.55, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6576, "minimum": 3310, "maximum": 10851.357, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 10522.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9864.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 7234.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5879.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6247.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "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": 6773.88, "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": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8746.85, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8549.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8220.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 6420.62 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5918.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6971.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10193.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6905.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10193.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6905.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 8549.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 10851.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5991.28 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "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": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 6576.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9404.51, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml", "drug_information": { "unit": 20, "type": "ML" }, "code_information": [ { "code": "10019003574", "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, "median_amount": 33.68, "10th_percentile": 33.68, "90th_percentile": 50.52, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7719, "minimum": 3310, "maximum": 13800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12350.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11578.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8491.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7584.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7333.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "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": 7950.87, "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": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10266.66, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10035.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9649.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8044.11 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6947.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8182.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11964.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8105.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11964.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8105.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10035.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12736.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5071.03 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "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": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7950.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7719.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11038.58, "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": 8421, "minimum": 3310, "maximum": 13894.8315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13473.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12631.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9263.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8075.38 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8000.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "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": 8673.74, "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": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11200.08, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10947.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10526.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9041.22 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7579, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8926.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13052.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8842.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13052.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8842.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10947.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13894.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5546.08 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "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": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8673.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8421.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12042.19, "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, "discounted_cash": 1607, "minimum": 561.57, "maximum": 12904, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2259.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3032.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.04 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4838.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3632.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 567.42 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 561.57 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 584.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% 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": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7836, "minimum": 3310, "maximum": 13340, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12537.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11754.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8619.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7277.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7444.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "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": 8071.22, "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": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10422.07, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10186.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9795.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8210.13 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7052.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8306.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12146.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8227.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12146.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8227.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 10186.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12929.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4559.09 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "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": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8071.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7836.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11205.68, "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, "minimum": 57.54, "maximum": 888, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14909, "minimum": 3310, "maximum": 24600.807, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 23855.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22364.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 16400.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16371.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14164.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "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": 15356.89, "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": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19829.74, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19382.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18637, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18259.67 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13418.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15804.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23109.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15655.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23109.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15655.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 19382.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 24600.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14909.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12590.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14909.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "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": 14909.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15356.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14909.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21320.7, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myocardial Imaging Pet Metabolic Evaluation", "code_information": [ { "code": "78459", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3895.87, "discounted_cash": 1294, "minimum": 231.95, "maximum": 3895.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1790 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2135.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1790 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1785.95, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1423.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 3895.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3319.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3895.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 836.55 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1229.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "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": 1333, "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": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 234.36 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1255.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1941.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1617.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1811.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1617.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1371.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 231.95 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2005.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2005.96, "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": 1358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 1682.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2135.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1572.72 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "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": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1333, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc O2 Uptk Exp Gas Analysis Rest&Xers Direct Simp", "code_information": [ { "code": "94680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.95, "discounted_cash": 128, "minimum": 45.81, "maximum": 706.95, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 136.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 157.09 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.36, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 163.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% 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": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 706.95 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.48, "additional_payer_notes": "103.00% 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": 257.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 576.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 484.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 640.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 706.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.72 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 192.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 128.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5957, "minimum": 3310, "maximum": 10580, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 9531.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8935.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 6552.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5376.82 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5659.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "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": 6135.92, "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": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7923.08, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7744.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7446.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 5540.64 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5361.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6314.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9233.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 6255.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9233.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6255.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 7744.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 9829.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3758.26 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "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": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6135.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 5957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8518.8, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "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": 8940.32, "discounted_cash": 3240, "minimum": 579.33, "maximum": 8940.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5347.22, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8940.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7936.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8940.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8940.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3143.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4861.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4050.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3435.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5023.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5347.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% 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": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3337.96, "additional_payer_notes": "103.00% 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": 6481.48, "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": 8477, "minimum": 3310, "maximum": 13987.0995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 13563.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9324.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8036.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8053.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "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": 8731.34, "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": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11274.45, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11020.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10596.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9120.67 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7629.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8985.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13139.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8900.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13139.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8900.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11020.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 13987.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6458.43 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "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": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8731.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 8477.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12122.15, "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": 7646, "minimum": 3310, "maximum": 12616.1805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 12233.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11469.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 8410.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7054.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7263.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "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": 7875.56, "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": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10169.41, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9940.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9557.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 7940.23 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6881.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8104.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11851.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 8028.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11851.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8028.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 9940.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 12616.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5662.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "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": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7875.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 7646.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10934.02, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "GENIOPLASTY, SLIDING OSTEOTOMY, SINGLE", "code_information": [ { "code": "21121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79871.26, "discounted_cash": 3314, "minimum": 886.62, "maximum": 63897.008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4573.65, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3645.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9350.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7019.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10398.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10398.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3148.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3413.67, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1967.35 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4971.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4639.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3513.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1947.07 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5137.07, "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": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2028.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 4308.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3413.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3378.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4533.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6628.48, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Excessive Skin Abdomen", "code_information": [ { "code": "15830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 6637, "minimum": 1629.9792, "maximum": 20792.0413, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10952.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9160.07, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7301.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18697.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14035.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20792.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20792.04 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6305.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "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": 6836.86, "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": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 4256.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6438.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 9956.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8297.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9292.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8297.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7035.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 4212.89 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10288.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6969.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10288.48, "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": 6969.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 4388.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 8629.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 10952.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "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": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1845.21 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 6637.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 7030.25 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 9434.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1845.21 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13275.46, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Vaginal Mucosa Simple", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2205.64, "discounted_cash": 920, "minimum": 47.06, "maximum": 1900, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 242.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1519.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% 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": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1278 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 47.06 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 948.33, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 179.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 240.6 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 47.06 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1841.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1519.17, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 177.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 133.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 197.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 197.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 235.25 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1150.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 975.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 232.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1427.1, "additional_payer_notes": "155.00% 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" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13295, "minimum": 3310, "maximum": 21938.2185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21273.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19943.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14625.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13036.89 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12631.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "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": 13694.78, "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": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17683.53, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17284.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16619.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15967.02 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11966.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14093.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20608.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13960.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20608.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13960.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17284.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 21938.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13295.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14862.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13295.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "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": 13295.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19013.12, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "EXC FACE TUM DEEP 2 CM>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21617.31, "discounted_cash": 2903, "minimum": 815.2, "maximum": 17293.848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3549.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2664.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3947.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3947.53 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1916.5 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1896.74 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1975.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% 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": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1278 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3105.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4167.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Vulva/Perineum 1 Lesion Spx", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735.21, "discounted_cash": 920, "minimum": 44.85, "maximum": 735.21, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 170.88 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 229.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 44.85 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 735.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 735.21 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 170.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 127.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 189.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 189.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "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": 735.21, "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": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.24 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 212.03 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "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": 735.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 220.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 735.21 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "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": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 44.85 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 735.21, "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": 11247, "minimum": 3310, "maximum": 18558.804, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 17996.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16871.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 12372.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11386.74 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10685.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "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": 11585.23, "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": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14959.52, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14622.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14059.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13057.17 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10122.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11922.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17434.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11810.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17434.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11810.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 14622.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 18558.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11247.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12962.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11247.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "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": 11247.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 11247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16084.3, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 2903, "minimum": 815.2, "maximum": 16551.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8278.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6214.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1256.74 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1243.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1295.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% 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": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3105.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4167.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open Tx Articular Fracture Mcp/Ip Joint Ea", "code_information": [ { "code": "26746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7224.4, "discounted_cash": 3270, "minimum": 468.14, "maximum": 7224.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7224.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7224.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7224.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7224.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2741.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2713.69 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2826.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% 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": 17904, "minimum": 3196.28, "maximum": 29542.755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 28647.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26857.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 19695.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17009.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "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": 18441.84, "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": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23813.25, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23276.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22380.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22514.96 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16114.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18978.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27752.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 18799.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27752.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18799.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 23276.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 29542.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3196.28 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "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": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18441.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 17904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25603.72, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 2903, "minimum": 815.2, "maximum": 16551.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8278.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6214.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9205.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1698.73 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1681.22 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1751.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4791.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% 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": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3105.91 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4167.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 815.2 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rpr Lac 2.5 Cm/< Pst One-Third Tongue", "code_information": [ { "code": "41251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1116.94, "discounted_cash": 236, "minimum": 72.3777, "maximum": 1116.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1116.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1116.94 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 726.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 545.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 808.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 808.45 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "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": 243.85, "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": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 671.53 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.65, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 355.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 295.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 331.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 295.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 250.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 664.6 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 366.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.96, "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": 248.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 692.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 307.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 390.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "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": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 87.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 236.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 333.68 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 447.77 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 87.58 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 473.5, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9087, "minimum": 3310, "maximum": 14994.8865, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "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": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9360.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12995.57, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 14540.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13631.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 9996.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9166.24 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8633.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "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": 9360.44, "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": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12086.79, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11814.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11359.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9988.43 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8179.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9633.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14086.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9542.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14086.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9542.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 11814.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 14994.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7679.87 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9087.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 } ] } ] }, { "description": "Excise foot tendon sheath", "code_information": [ { "code": "28086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22332.5, "discounted_cash": 3270, "minimum": 1088.27, "maximum": 17866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1307.86 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1294.37 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1348.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE MANDIBLE LESION", "code_information": [ { "code": "21040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4395.83, "discounted_cash": 3314, "minimum": 284.8498, "maximum": 4395.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3645.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4395.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4395.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4395.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4395.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3148.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3413.67, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1351.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4142.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3513.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1337.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "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": 3479.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1393.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 4308.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "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": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3413.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3314.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3378.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.83 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 886.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4395.83, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE WRIST TENDON SHEATH", "code_information": [ { "code": "25118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9648.67, "discounted_cash": 1607, "minimum": 593.04, "maximum": 7718.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4838.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3632.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1431.58 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1416.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1475.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% 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": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2259.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3032.05 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.04 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "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": 19681, "minimum": 3310, "maximum": 32475.036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 31490.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29522.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 21650.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23454.58 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18697.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "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": 20272.25, "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": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26176.85, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25586.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24602.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25039.82 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17713.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20862.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30506.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 20665.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30506.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20665.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 25586.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 32475.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20872.4 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 19681.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "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": 19681.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20272.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 19681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28145.03, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Vaginal Mucosa Extensive", "code_information": [ { "code": "57105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4870.3, "discounted_cash": 3235, "minimum": 315.5954, "maximum": 4870.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4870.3, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4870.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4870.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4870.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4870.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 544.79 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 539.17 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4870.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4870.3, "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": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 561.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 4870.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% 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": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4052.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4870.3 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4870.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14344, "minimum": 3310, "maximum": 23668.722, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 22951.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21517.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 15779.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15272.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13627.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "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": 14775.04, "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": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19078.42, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18648.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17930.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17457.09 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12910.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15205.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22234.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 15061.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22234.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15061.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 18648.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 23668.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14344.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11151.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14344.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "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": 14344.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14775.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 14344.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20512.89, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cysto W/Ureteroscopy W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9301.95, "discounted_cash": 5359, "minimum": 602.7664, "maximum": 9301.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7358 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9301.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9301.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9301.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9301.95 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1398.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5199.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8039.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6699.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5681.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1384.54 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1442.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% 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": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4754 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1689.43 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5520.62, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 6436.73 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 8637.58 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1689.43 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9301.95, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruction Lesions Vulva Simple", "code_information": [ { "code": "56501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5001.45, "discounted_cash": 2062, "minimum": 111.02, "maximum": 4125.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 369.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 277.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 411.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 411.21 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 497.65 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 492.52 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 513.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 111.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 422.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 567.61 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 111.02 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Irrigation Vagina&/Appl Medicament Tx Disease", "code_information": [ { "code": "57210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6276.4, "discounted_cash": 3235, "minimum": 406.71, "maximum": 6276.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6276.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6276.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6276.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6276.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1449.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1435.01 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1494.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% 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": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4052.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5437.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6276.4, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open Tx Metacarpal Fracture Single Ea Bone", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2960.24, "discounted_cash": 3270, "minimum": 191.82, "maximum": 28848.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "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": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2139.35 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2117.29 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2205.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plmt Expandable Cath Brst Following Prtl Mast", "code_information": [ { "code": "19296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8922.15, "discounted_cash": 8170, "minimum": 578.1553, "maximum": 8922.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7761.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "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": 8415.51, "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": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 742.03 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7925.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8660.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 734.38 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 8578.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "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": 8578.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 764.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "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": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 3510.18 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 8170.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 8922.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3510.18 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8922.15, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "FACE BONE GRAFT", "code_information": [ { "code": "21210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3934.97, "discounted_cash": 5917, "minimum": 254.9861, "maximum": 3934.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "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": 3934.97, "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": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2800.19 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2771.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "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": 3934.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2886.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "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": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3934.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.22 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3934.97, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22066, "minimum": 3310, "maximum": 36409.197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 35305.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33099.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 24272.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 24260.27 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20962.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "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": 22728.19, "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": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29348.02, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28686.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27582.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 28427.35 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19859.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23390.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34202.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 23169.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34202.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23169.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 28686.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 36409.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22066.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25795.9 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 22066.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "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": 22066.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22728.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 22066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31554.64, "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": 53476, "minimum": 3310, "maximum": 88236.951, "payers_information": [ { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 80215.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 58824.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50803.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "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": 55081.21, "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": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71124.33, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 69520.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66846.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 73053.95 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 48129.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56685.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 82889.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 56150.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 82889.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 56150.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 69520.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 88236.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53476.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30210.2 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 53476.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "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": 53476.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 55081.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76472.02, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 85563.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53476.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25146, "minimum": 3310, "maximum": 41491.9065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 40234.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37719.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 27661.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23889.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "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": 25901, "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": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33444.99, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32690.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31433.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32803.85 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22631.95, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26655.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38977.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 26403.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38977.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26403.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 32690.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 41491.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25146.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15299.1 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 25146.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "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": 25146.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25901, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 25146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35959.65, "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": 12644, "minimum": 3310, "maximum": 20862.996, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 20230.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18966.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 13908.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 13952.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12012.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "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": 13023.53, "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": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16816.84, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16437.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15805.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15041.21 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11379.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13402.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19598.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13276.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19598.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13276.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 16437.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 20863, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12644.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10987.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12644.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "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": 12644.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13023.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 12644.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18081.26, "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": 13343, "minimum": 3310, "maximum": 22016.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 21349.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20014.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 14677.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14388.01 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12676.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "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": 13743.5, "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": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17746.46, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17346.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16679, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16034.25 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12008.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14143.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20681.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 14010.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20681.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14010.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 17346.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 22016.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13645.7 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "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": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 13343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19080.78, "additional_payer_notes": "143.00% 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": 9386, "minimum": 3310, "maximum": 15486.9495, "payers_information": [ { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14079.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 10324.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9175.47 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8916.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "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": 9667.61, "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": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12483.42, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12201.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11732.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10412.13 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8447.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9949.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14548.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9855.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14548.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9855.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 12201.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 15486.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8551.81 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "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": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13422.02, "additional_payer_notes": "143.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 15017.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9386.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16139, "minimum": 3310, "maximum": 26629.3995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "case rate", "standard_charge_dollar": 25822.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24208.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "case rate", "standard_charge_dollar": 17752.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16554.98 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15332.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "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": 16623.17, "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": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21464.91, "additional_payer_notes": "133.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20980.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20173.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20006.4 }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14525.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17107.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25015.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16945.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25015.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16945.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "case rate", "standard_charge_dollar": 20980.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "case rate", "standard_charge_dollar": 26629.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16348.5 }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3310 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "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": 16139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16623.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "case rate", "standard_charge_dollar": 16139, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23078.81, "additional_payer_notes": "143.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Vulva/Perineum Each Addl Lesion", "code_information": [ { "code": "56606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.9, "minimum": 45.4183, "maximum": 700.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 700.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 700.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 221.92 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.89 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 104.8 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 109.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "Hc Bladder Instillation Anticarcinogenic Agent", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.73, "discounted_cash": 697, "minimum": 40.48, "maximum": 624.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 624.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 624.73 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 182.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 137.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 203.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 203.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "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": 624.73, "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": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.38 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 155.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "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": 624.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 162.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "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": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 44.85 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 170.88 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 229.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 44.85 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ca Screen;Pelvic/Breast Exam", "code_information": [ { "code": "G0101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.52, "discounted_cash": 101, "minimum": 5.28, "maximum": 81.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "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": 81.52, "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": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "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": 81.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "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": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colposcopy Vulva W/Biopsy", "code_information": [ { "code": "56821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.9, "discounted_cash": 304, "minimum": 45.4183, "maximum": 700.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 700.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 700.9 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 283.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 212.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 315.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 315.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 408.76 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 295.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 456.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 322.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 404.54 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 421.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% 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": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 72.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.75, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 276.38 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 370.88 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 72.54 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 609.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruction Vaginal Lesions Simple", "code_information": [ { "code": "57061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2859.2, "discounted_cash": 3235, "minimum": 98.83, "maximum": 2859.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 327.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 245.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 363.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 363.93 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "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": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.51 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 425.09 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 442.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.83 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 376.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 505.29 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.83 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Initial Observation Care/Day 30 Minutes", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.6, "minimum": 19.44, "maximum": 746.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 535.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 535.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 535.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 535.6 }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 6.48, "median_amount": 94.48, "10th_percentile": 94.48, "90th_percentile": 1417.18, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 6.48, "median_amount": 1492.21, "10th_percentile": 1492.21, "90th_percentile": 1492.21, "count": "1 through 10" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 535.6 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.4 } ] } ] }, { "description": "Hc Myocardial Perfusion Planar 1 Study Rest/Stress", "code_information": [ { "code": "78453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3618.55, "discounted_cash": 1294, "minimum": 272.65, "maximum": 3618.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2135.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.48 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1785.95, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1423.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1184.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 717.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1317.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1907.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1229.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "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": 1333, "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": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 899.07 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1255.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1941.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1617.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1811.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1617.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1371.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 889.81 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2005.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2005.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1325.08 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 926.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 1682.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1014.26 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2135.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1384.34 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 272.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 1014.26 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1333, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 1294.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plastic Repair Introitus", "code_information": [ { "code": "56800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2859.2, "discounted_cash": 3235, "minimum": 185.2762, "maximum": 2859.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "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": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 930.06 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 920.47 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 958.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "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": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2859.2 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1063.52 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2859.2, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Extensor Tendon Finger W/Graft Each", "code_information": [ { "code": "26420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6934.35, "discounted_cash": 3270, "minimum": 449.3459, "maximum": 6934.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6934.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6934.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6934.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6934.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2801.34 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2772.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2887.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.35, "minimum": 15.83, "maximum": 244.35, "payers_information": [ { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 32.78 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 34.14 } ] } ] }, { "description": "Hc (Sup Shell C1788) Port Indwelling", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 858, "10th_percentile": 858, "90th_percentile": 858, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1897) Lead, Neurostim Test Kit", "code_information": [ { "code": "C1897", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 7440, "10th_percentile": 7440, "90th_percentile": 7440, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 2836.8, "10th_percentile": 2803.2, "90th_percentile": 2836.8, "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": 732.26, "discounted_cash": 783, "minimum": 47.45, "maximum": 4436, "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "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": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "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": 732.26, "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": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 732.26 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 732.26, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16800, "discounted_cash": 7796, "minimum": 1088.64, "maximum": 16800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12864.74, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16800 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15773.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16800 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 16800 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1648.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7562.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 11695.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9746.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8264.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1631.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12085.06, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1699.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 12864.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7796.81, "additional_payer_notes": "100.00% 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": 7796.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7181 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8030.71, "additional_payer_notes": "103.00% 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": 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, "minimum": 22.9062, "maximum": 353.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.91, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.79 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 187.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 195.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 330.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% 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": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.57, "additional_payer_notes": "103.00% 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": 353.49, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "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": 3640, "discounted_cash": 2062, "minimum": 235.87, "maximum": 17724.88, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3640, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3640 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3640 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3640 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2291.94 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2268.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2362.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3624.97 } ] } ] }, { "description": "Hc Adjnt Tis Transfr/Rearrange Trunk 10.1-30.0 Sqcm", "code_information": [ { "code": "14001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7424.4, "discounted_cash": 2062, "minimum": 481.1, "maximum": 6442.2778, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2380.51 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2355.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2454.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3624.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjt/Reargmt F/C/C/M/N/Ax/G/H/F 10.1-30.0 Sq Cm", "code_information": [ { "code": "14041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6206.05, "discounted_cash": 2062, "minimum": 402.15, "maximum": 6206.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6206.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6206.05 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2799.38 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2770.52 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2885.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3624.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1822) Gen, Neuro, Hf, Rechg Bat", "code_information": [ { "code": "C1822", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 20000.99, "10th_percentile": 20000.99, "90th_percentile": 20000.99, "count": "1 through 10" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.44, "discounted_cash": 46, "minimum": 2.81, "maximum": 43.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "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": 43.44, "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": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "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": 43.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "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": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Albumin (Human), 25%, 50Ml", "code_information": [ { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.65, "discounted_cash": 53, "minimum": 17.9269, "maximum": 276.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.25, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 185.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 217.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 175.07 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "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": 54.67, "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": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 131.67 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 79.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 55.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "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": 55.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 135.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 87.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "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": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 53.08 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 202.23 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 53.08 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.15, "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": 268.8, "discounted_cash": 13, "minimum": 11.29, "maximum": 268.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 63.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.49 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.41 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 34.05 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 35.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% 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": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.33 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 42 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "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": 880.17, "discounted_cash": 304, "minimum": 57.035, "maximum": 880.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 880.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 880.17 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 488.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 366.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 543.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 543.06 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 622.66 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 295.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 456.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 322.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 616.24 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 641.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 502.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.61, "additional_payer_notes": "100.00% 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": 304.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 116.74 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.75, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 444.78 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 596.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 116.74 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 609.22, "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": 14801.2, "discounted_cash": 3270, "minimum": 959.1178, "maximum": 16551.2, "payers_information": [ { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2618.48 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2727.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2645.76 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Toe Interphalangeal Joint", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2960.24, "discounted_cash": 3270, "minimum": 191.82, "maximum": 2960.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "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": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 626.74 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 620.28 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 646.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2960.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2960.24, "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": 3960.05, "discounted_cash": 906, "minimum": 256.61, "maximum": 3168.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2805.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2106.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3120.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3120.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 385.2 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 879.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1133.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 381.23 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 397.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1495.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% 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": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 334.95 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 933.85, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 1276.16 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 1712.51 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 334.95 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "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": 2915.1, "discounted_cash": 3156, "minimum": 127.26, "maximum": 2915.1, "payers_information": [ { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 497.51 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 518.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 571.76 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 571.76 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "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": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 498.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 301.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "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": 2915.1, "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": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 502.69 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdomen Surgery Procedure", "code_information": [ { "code": "22999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5707.5, "discounted_cash": 246, "minimum": 234.251, "maximum": 5707.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 406.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.28, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 769.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 577.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 856.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 856.09 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 234.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "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": 253.98, "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": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 239.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 369.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 308.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 261.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "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": 258.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 320.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 406.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "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": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 493.16, "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": 7812, "discounted_cash": 3156, "minimum": 94.24, "maximum": 7812, "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": 5207.93, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7812 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7482.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7812 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7812 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 526.1 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 520.68 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 542.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.55 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% 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": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 606.55 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% 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": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abrasion, Each Addn 4 Or Less", "code_information": [ { "code": "15787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.95, "minimum": 27.4072, "maximum": 422.95, "payers_information": [ { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.08 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 62.97 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 422.95 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14160, "discounted_cash": 5562, "minimum": 101.74, "maximum": 14160, "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": 9178.04, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.74 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14160 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12409.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14160 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 554.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 557.53 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 551.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 574.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 632.7 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9178.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% 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": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5416.34 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 632.7 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% 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": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.4, "discounted_cash": 12, "minimum": 10.81, "maximum": 257.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 79.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 32.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 33.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% 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": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.55 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "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": 270, "discounted_cash": 8, "minimum": 7.27, "maximum": 270, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65, "median_amount": 27.94, "10th_percentile": 27.94, "90th_percentile": 27.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 212.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.15 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.04 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% 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": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 27.04 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjt Tis Reargmt Eye/Nose/Ear/Lip 10.1-30.0 Sqcm", "code_information": [ { "code": "14061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5911.3, "discounted_cash": 2062, "minimum": 383.05, "maximum": 5911.3, "payers_information": [ { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2975.34 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3099.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3624.97 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5911.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5911.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 3006.33 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.8, "discounted_cash": 12, "minimum": 10.16, "maximum": 241.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.04 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.95 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.8 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% 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": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.8 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjt Tis Trnsfr/Reargmt Scalp/Arm/Leg 10 Sq Cm/<", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3617.15, "discounted_cash": 2062, "minimum": 234.39, "maximum": 3617.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3617.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3617.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3617.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3617.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2082.04 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2060.57 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2146.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 3617.15 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3617.15, "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": 8338.93, "discounted_cash": 738, "minimum": 334.67, "maximum": 6671.144, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 348.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% 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": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 363.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 338.15 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 334.67 } ] } ] }, { "description": "Hc Adjt Tis Trnsfr/Rearrgmt E/N/E/L Dfct 10 Sq Cm/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1667.79, "discounted_cash": 2062, "minimum": 108.07, "maximum": 1667.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "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": 1667.79, "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": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1667.79 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1667.79 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "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": 1667.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1667.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "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": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 1667.79 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1667.79, "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": 1416.5, "minimum": 91.7892, "maximum": 1416.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1416.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1416.5 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.33 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 156.69 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 163.22 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "Hc Adjustment/Revj Xtrnl Fixation System Req Anes", "code_information": [ { "code": "20693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9363.65, "discounted_cash": 7253, "minimum": 606.76, "maximum": 9363.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9363.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9363.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9363.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9363.65 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1634.03 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1617.18 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1684.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% 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": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 2398.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 9138.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 9363.65 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2398.52 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9363.65, "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": 8338.93, "discounted_cash": 738, "minimum": 297.74, "maximum": 6671.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 300.84 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 716.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 923.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 297.74 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 310.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1219, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% 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": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.95, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4012.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "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, "minimum": 6.69, "maximum": 120.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11, "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 94.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 20.19 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 21.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% 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": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "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": 9414.08, "discounted_cash": 10625, "minimum": 610.03, "maximum": 9414.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "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": 9414.08, "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": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1649.88 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1632.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "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": 9414.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1700.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "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": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.39 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 9414.08 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.39 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9414.08, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Interdental Fixation Device Non-Fx/Dislc", "code_information": [ { "code": "21110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4184.17, "discounted_cash": 1551, "minimum": 271.13, "maximum": 3347.336, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2016.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2559.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "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": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 420.64 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1597.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 1602.64 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2150.61 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 420.64 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3102.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2140.39, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1706.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1915.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1438.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2130.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2130.3 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1473.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "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": 1597.54, "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": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2704.6 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1504.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2326.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1938.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1938.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1644.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2676.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2404.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1628.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2404.07, "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": 1628.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2788.25 } ] } ] }, { "description": "Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14801.2, "discounted_cash": 3270, "minimum": 959.1178, "maximum": 18898.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9772.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7336.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 10867.68 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2579.63 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2553.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 2659.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5396.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 4146.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 5564.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1088.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablation Bone Tumor W/ Img Gdn When Prfmd", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6542.72, "discounted_cash": 7253, "minimum": 423.9683, "maximum": 6542.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6542.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6542.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6542.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6542.72 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "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": 6542.72, "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": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 1232.41 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 1219.71 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "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": 6542.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 1270.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5281 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "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": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6542.72, "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, "minimum": 104.81, "maximum": 465, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 196.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 147.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 218.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 218.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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, "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, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.91 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 104.81 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 109.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "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, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.3, "discounted_cash": 95, "minimum": 41.945, "maximum": 647.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 178.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 190.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.81 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 142.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 116.6 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 121.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.03, "additional_payer_notes": "100.00% 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": 95.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.88, "additional_payer_notes": "103.00% 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": 190.06, "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": 60.25, "discounted_cash": 12, "minimum": 10.12, "maximum": 60.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.85 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "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, "minimum": 126.35, "maximum": 729.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 389.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 292.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 432.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 432.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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, "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, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.92 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 146.4 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 152.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "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, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266, "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": 2915.1, "discounted_cash": 3156, "minimum": 182.78, "maximum": 2915.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "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": 2915.1, "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": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 608.1 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 601.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 626.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 679.94 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 182.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 679.94 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "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": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.52 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.77, "discounted_cash": 46, "minimum": 11.26, "maximum": 173.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 83.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 173.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.25 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.54, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 79.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% 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": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "103.00% 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": 93.6, "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": 720.52, "discounted_cash": 162, "minimum": 40.14, "maximum": 576.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 177.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 133.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 197.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 197.71 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.01 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 148.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 154.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% 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": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 40.14 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% 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": 324.88, "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": 2915.1, "discounted_cash": 3156, "minimum": 93.14, "maximum": 2915.1, "payers_information": [ { "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": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "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": 2915.1, "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": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 427.41 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 423.01 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": 2915.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 440.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 483.53 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 2915.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 483.53 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2915.1, "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": 321.4, "discounted_cash": 16, "minimum": 13.5, "maximum": 321.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 321.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.14 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 40.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 42.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.22 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% 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": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.36 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 50.22 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7349.31, "discounted_cash": 1607, "minimum": 476.2353, "maximum": 7349.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4838.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3632.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5380.9 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 840.98 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 832.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 866.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% 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": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% 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": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy Ablation Lesion", "code_information": [ { "code": "46615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2567.86, "discounted_cash": 2774, "minimum": 166.3973, "maximum": 2567.86, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "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": 2567.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 338.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1975 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "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": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 939.93 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 939.93 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2567.86 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "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": 2567.86, "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": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 328.09 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2567.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 324.71 } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 996.3, "discounted_cash": 218, "minimum": 26.88, "maximum": 996.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 767.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 851.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 851.73 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.16 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": 6.48, "median_amount": 313.76, "10th_percentile": 120.73, "90th_percentile": 313.76, "count": "1 through 10" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 361.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% 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": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 181 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 225.46, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 47, "median_amount": 172.56, "10th_percentile": 172.56, "90th_percentile": 654.5, "count": "1 through 10" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 437.78, "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": 161.4, "discounted_cash": 8, "minimum": 6.78, "maximum": 161.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.64 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.66 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 21.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.22 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% 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": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 25.22 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "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": 1079.23, "discounted_cash": 1196, "minimum": 69.93, "maximum": 1079.23, "payers_information": [ { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1079.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "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": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 201.27 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 766.84 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 1029.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 201.27 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1079.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1079.23 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 762.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 572.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 848.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 848.19 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "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": 1079.23, "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": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 271.58 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 268.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "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": 1079.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 279.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "100.00% 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, "minimum": 4.38, "maximum": 32.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.2 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.36 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.29 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.29 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "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": 1334.15, "discounted_cash": 306, "minimum": 47.34, "maximum": 1334.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1334.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1334.15 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 186.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 140.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 207.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 207.75 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.11 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 213.88 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 222.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 506.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% 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": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 47.34 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.05, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 180.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 242.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 47.34 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% 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": 1417.8, "minimum": 91.87, "maximum": 1417.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1417.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1417.8 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 198.4 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 196.36 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 204.54 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965, "discounted_cash": 170, "minimum": 61.47, "maximum": 965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 683.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 502.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 759.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 759.12 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 457.66 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 452.94 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 471.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 281, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% 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": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 61.47 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.41, "additional_payer_notes": "103.00% 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": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrodesis Sacroiliac Joint", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82566.8, "discounted_cash": 17527, "minimum": 1900, "maximum": 82566.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24187.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19280.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 56927.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 42735.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 63305.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 63305.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16651.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 18053.22, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 2949.8 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17001.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 26291.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24538.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21909.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18579.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 2919.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27167.47, "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": 18403.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 3041.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 22785.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 28920.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6864 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "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": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18053.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 17527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35054.8, "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": 53.8682, "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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.89 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 59.27 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 61.74 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5857.94, "discounted_cash": 3156, "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": 5207.93, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.06 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5857.94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 555.72 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 549.99 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 572.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 642.63 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% 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": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 642.63 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% 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": 5857.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrp Knee Condyle&Plateau Medial/Lat Cmprt", "code_information": [ { "code": "27446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19164.1, "discounted_cash": 12833, "minimum": 1241.83, "maximum": 19164.1, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "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": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 7073.75 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7073.75 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17710.89, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14117.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 19164.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12192.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "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": 13219, "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": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 4161.68 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13604.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 4118.77 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "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": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 4290.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19164.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6864 } ] } ] }, { "description": "Hc Appl Clubfoot Cast Molding/Manj Long/Short Leg", "code_information": [ { "code": "29450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.5, "discounted_cash": 162, "minimum": 14.35, "maximum": 221.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "165.00% 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 221.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 175.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 221.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 221.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 221.5 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 221.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 221.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% 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": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 221.5 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 53.98 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 205.66 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 221.5 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 53.98 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.5, "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, "discounted_cash": 3156, "minimum": 94.68, "maximum": 8083, "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": 5207.93, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.68 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8083 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7482.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8083 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 461.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 483.84 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 478.86 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 498.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.41 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 5207.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% 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": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 549.41 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% 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": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.75, "discounted_cash": 11, "minimum": 10.06, "maximum": 253.75, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.36 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 79.35 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.67 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.35 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% 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": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.06 } ] } ] }, { "description": "Hc Application Cast Finger", "code_information": [ { "code": "29086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.1, "discounted_cash": 162, "minimum": 13.6793, "maximum": 211.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "165.00% 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 194.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 146.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 211.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 211.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 180.89 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "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": 170.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 188.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% 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": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 211.1 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 42.36 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 161.39 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 211.1 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 42.36 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.1, "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": 210.65, "discounted_cash": 42, "minimum": 18.32, "maximum": 172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.51, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.26 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.86 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.35, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172 }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 111.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.65 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 69.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% 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": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 131.65 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.32 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 69.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.04 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.32 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.26, "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": 643.45, "discounted_cash": 707, "minimum": 41.6956, "maximum": 643.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 643.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 643.45 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 280.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 210.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 312.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 312.36 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "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": 643.45, "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": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 175.76 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 173.95 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "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": 643.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 181.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 643.45 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "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": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 59.52 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 226.77 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 304.31 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 59.52 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 643.45, "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": 584.12, "discounted_cash": 133, "minimum": 126.35, "maximum": 467.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 389.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 292.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 432.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 432.85 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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, "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, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 179.1 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 186.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "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, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266, "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": 1840.6, "discounted_cash": 348, "minimum": 135.99, "maximum": 1840.6, "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": 575.42, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1703.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1031 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1840.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1840.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 454.48 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 523.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 369.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 449.8 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 468.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 505.88 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 575.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% 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": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 309.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 505.88 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 359.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.48, "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": 309.9, "discounted_cash": 14, "minimum": 12.42, "maximum": 309.9, "payers_information": [ { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 70.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 87.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.84 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.07, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 37.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 39.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% 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": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1228.04, "discounted_cash": 279, "minimum": 49.28, "maximum": 982.432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 215.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 161.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 239.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 239.27 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 248.7 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 246.14 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 256.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% 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": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 49.28 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% 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": 559.16, "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": 167.82, "discounted_cash": 58, "minimum": 4.53, "maximum": 167.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 159.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 117.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 167.82 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 13.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% 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": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% 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": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Anti-Mullerian Horm", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210, "discounted_cash": 38, "minimum": 32.44, "maximum": 210, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% 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": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 183.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 135.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 204.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 127.44 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.82, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% 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": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast,Walker", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1228.04, "discounted_cash": 279, "minimum": 35.99, "maximum": 982.432, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 162.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 121.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 180.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 180.52 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 198.74 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 196.7 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 204.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% 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": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 35.99 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% 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": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12, "minimum": 10.12, "maximum": 60.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.85 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "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": 188.25, "discounted_cash": 3, "minimum": 3.3, "maximum": 188.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 10.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% 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": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "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": 60.25, "discounted_cash": 12, "minimum": 10.12, "maximum": 60.25, "payers_information": [ { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.85 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.2, "discounted_cash": 5, "minimum": 4.85, "maximum": 135.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 14.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 15.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% 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": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "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": 333.4, "discounted_cash": 16, "minimum": 14, "maximum": 333.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23, "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 79.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 333.4 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.68 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.08 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% 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": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 52.08 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 301, "discounted_cash": 15, "minimum": 12.64, "maximum": 301, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 71.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 68.14 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 38.13 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 39.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "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": 237, "discounted_cash": 11, "minimum": 9.95, "maximum": 237, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 56.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.18 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.34 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.03 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.01 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% 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": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 37.01 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "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, "discounted_cash": 38, "minimum": 32.44, "maximum": 727, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 183.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 135.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 204.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 136.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.87 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.82, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 97.85 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% 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": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 52.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 32.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "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": 103.6, "discounted_cash": 5, "minimum": 4.35, "maximum": 103.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 13.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anus Surgery Procedure Unlisted", "code_information": [ { "code": "46999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1876.15, "discounted_cash": 929, "minimum": 121.57, "maximum": 1876.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1533.86, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1876.15 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 901.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 1394.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1162.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 985.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1440.9, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 1533.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% 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": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1278 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 957.5, "additional_payer_notes": "103.00% 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": 1859.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "discounted_cash": 13, "minimum": 11.49, "maximum": 273.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.42 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 70.57 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 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": 13.68, "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": 14.09, "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": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.02 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 34.66 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.84 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 36.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "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": 301.6, "discounted_cash": 15, "minimum": 12.67, "maximum": 301.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 71.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 98.61 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.61 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 38.21 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.13 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% 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": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 47.13 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "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": 8338.93, "discounted_cash": 2062, "minimum": 540.36, "maximum": 6671.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5793.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4348.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6442.28 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 802.36 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 794.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 827.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 1745 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 2701.33 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 4012.82 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 709.01 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.8, "discounted_cash": 10, "minimum": 9.02, "maximum": 214.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 74.69 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "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": 11.06, "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": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 28.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.4, "discounted_cash": 14, "minimum": 12.24, "maximum": 291.4, "payers_information": [ { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "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": 15.01, "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": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.3 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 36.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.53 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 45.53 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "138.00% 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": 752.9, "minimum": 48.7879, "maximum": 752.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 752.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 752.9 }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 89.87 }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 88.94 }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 92.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175, "discounted_cash": 6, "minimum": 5.47, "maximum": 175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "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": 6.71, "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": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.35 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.35 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "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": 379.4, "discounted_cash": 18, "minimum": 15.93, "maximum": 379.4, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 90.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 52.32 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.57 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.47, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 50.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.26 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% 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": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 59.26 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16405.3, "discounted_cash": 2062, "minimum": 691.28, "maximum": 13124.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1900 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10628.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7979.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11819.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11819.84 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 698.48 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2000.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2578.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 691.28 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 720.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 3403.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% 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": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3485 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 1457.62 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.4, "additional_payer_notes": "103.00% 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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR KIDS", "methodology": "case rate", "standard_charge_dollar": 5553.53 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR Medicaid", "methodology": "case rate", "standard_charge_dollar": 8005.8 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup STAR PLUS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1457.62 }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.8, "discounted_cash": 13, "minimum": 11.25, "maximum": 267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 63.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.1 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "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": 13.79, "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": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.28 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 33.93 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.68 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 35.34 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 41.85 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.5, "discounted_cash": 10, "minimum": 8.82, "maximum": 52.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 52.5 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "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": 10.82, "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": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.02 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "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, "discounted_cash": 58, "minimum": 56.0215, "maximum": 293, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 196.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 147.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 218.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 218.39 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 126.26 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 124.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 130.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% 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": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% 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": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434, "discounted_cash": 21, "minimum": 18.23, "maximum": 434, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 103.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 127.91 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "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": 22.35, "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": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.56 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 54.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.6 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 57.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 35.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 67.82 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.6, "discounted_cash": 6, "minimum": 5.07, "maximum": 120.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.26 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "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": 6.21, "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": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 15.28 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.64 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 15.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.86 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 18.86 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "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": 1228.04, "discounted_cash": 279, "minimum": 45.13, "maximum": 982.432, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 219.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 219.22 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 228.96 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 226.6 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 236.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% 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": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 45.13 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% 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": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 197.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 147.99 } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.6, "discounted_cash": 13, "minimum": 11.45, "maximum": 272.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 272.6 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "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": 14.04, "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": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.89 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.58, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 34.54 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.65 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.59 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 42.59 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.2, "discounted_cash": 12, "minimum": 10.42, "maximum": 248.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.13, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 119.13 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "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": 12.78, "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": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 31.44 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.64 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.76 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 38.76 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "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, "minimum": 48.45, "maximum": 953.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 207.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 155.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 230.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 230.66 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.95 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 188 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 195.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% 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": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 48.45 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% 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": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.1, "discounted_cash": 14, "minimum": 12, "maximum": 288.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "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": 14.72, "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": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.58 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 36.21 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.32 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 37.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.64 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 44.64 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyanide", "code_information": [ { "code": "82600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.8, "discounted_cash": 19, "minimum": 16.3, "maximum": 627.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.28 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 79.77 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "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": 19.98, "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": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 49.67 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 49.16 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.22 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 51.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.64 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "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": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.46 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 60.64 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "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": 2127.47, "discounted_cash": 162, "minimum": 56.48, "maximum": 1701.976, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 98.74 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 102.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% 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": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 56.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.31, "additional_payer_notes": "103.00% 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": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.03, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 241.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 181.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 268.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 268.29 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.77 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.05, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.2, "discounted_cash": 12, "minimum": 10.17, "maximum": 242.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% 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": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.33 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 31 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 31.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% 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": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "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": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392, "discounted_cash": 24, "minimum": 20.96, "maximum": 392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.94 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 118.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 147.8 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "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": 25.7, "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": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.88 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 37.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.19, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 63.22 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.87 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 65.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.97 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 34.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 77.97 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1080.95, "discounted_cash": 279, "minimum": 49.56, "maximum": 864.76, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% 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": "Naphcare", "plan_name": "Naphcare Medicare", "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": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 369.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan 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", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% 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": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 465 }, { "payer_name": "United HealthCare", "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": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "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": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup CHIP Medicaid", "methodology": "case rate", "standard_charge_dollar": 49.56 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.97, "additional_payer_notes": "103.00% 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": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "165.00% 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 Medicare", "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", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 221.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 166.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 246.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 246.42 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network 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": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 358.54 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "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": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 354.85 } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175, "discounted_cash": 6, "minimum": 5.63, "maximum": 175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 65, "median_amount": 8.04, "10th_percentile": 8.04, "90th_percentile": 8.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "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": 6.9, "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": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.15 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.64, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 16.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214, "discounted_cash": 14, "minimum": 12.52, "maximum": 214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 70.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 138.81 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "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": 15.35, "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": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.15 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "Laboratory - 129.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Parkland Medicaid", "plan_name": "Parkland Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.85 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 39.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Star Kids MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "United HealthCare", "plan_name": "UHC MEDCAID", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR KIDS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC STAR PLUS MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 46.57 }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup MMP (Dual-Eligible)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.4, "discounted_cash": 37, "minimum": 10.78, "maximum": 166.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "American Correction Healthcare", "plan_name": "American Correction Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.18, "additional_payer_notes": "138.00% of Medicare Rates" }, { "payer_name": "American Health Plan", "plan_name": "American Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Essentials Medicare-HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 165.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 138.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 143.48 }, { "payer_name": "Care N Care Insurance Company", "plan_name": "Care NCare Insurance Company Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Fka (Rockport Community Network)", "plan_name": "Careworks Fka - Rockport Community Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "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": 38.2, "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": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coastal Comp", "plan_name": "Coastal Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.98 }, { "payer_name": "Coastal Comp", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies", "plan_name": "Corporate Remedies", "methodology": "fee schedule", "standard_charge_dollar": 55.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "DOL Office Worker Compensation", "plan_name": "DOL Office Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HI Card", "plan_name": "HI Card Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Choice Care Humana Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Injury Management Org", "plan_name": "Injury Management Org", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 38.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.49, "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": 38.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Sedgwick", "plan_name": "Sedgwick", "methodology": "fee schedule", "standard_charge_dollar": 115.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange-EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage/MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Commercial HMO/PPO/EPO", "methodology": "fee schedule", "standard_charge_dollar": 61.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Bluebonnett Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas First HP", "plan_name": "First HP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST (BCBS)", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 87 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "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": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed", "plan_name": "Wellmed Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Me